Thursday, December 29, 2011

" Cheating" Radiology Colleague



How many of us have sometimes felt to be on wrong side of a cheating colleague. In my last job there were say 3 odd radiologists all on a fixed payroll in a hospital and hospital management would keep a track on our work based on number of CT and MRIs that we reported. One of the colleagues had this odd habit of picking up the straight forward normal cases where all you had to write or dictate was “normal” and get his number for the day to 10 and push just one case of complicated case to me which would require some brain storming, googling, dictation and explaining to the referring physician but as per the hospital management i had done only 2 cases that day.  Later on we started to randomly report alternate cases to eliminate such filtering of cases.
In our own consult service where we offer teleradiology services, some of the centres for which we report, there is a radiologist on site. Invariably, i see one of them just pushing one of the odd cases to us and managing most of the simpler cases and at the end we get paid for one case and they appear useful/efficient to the management. 
Is this different in your settings? Does your management think only in terms of numbers not the kind of cases / opinion you are offering? What do you think? Does this happen where radiologists are reimbursed per case ? Is this a fixed pay package phenomenon?

6 comments:

Dr Haider NA said...

Dear Dr. Sumer,
Althogh the financial apsect is surely one of causes for this behavior, I think the issue is essentially an "ethical" one. If that radiologist is a well-mannered and responsible man, whatever money is considered, he will behave ethicaly and take his responsibilty and would not follow the bad quete of 'if you clever, shift to other"

Karunakaran said...

Yeah , I have came across few of these escapists... I feel this is an apt terminology !!!!

It happened once to me an escapist loaded bottles and bottles of oral contrast to a patient with intestinal obstruction just to tide over the time so that he can escape the situation, that the blunder and the burden falls upon the successive duty radiologist.

u have raised an wonderful scenario.... In my experience I would like 2 suggest few ideas to overcome these troubles...

1.In case, If we are working with many radiologists, Its appropriate to divide the modalities in turns whatsoever happens.

2. the person who writes the protocol should take incharge of cases, even if it happens to postpone the reports to next day.

3.working in "points" i.e.., money for the number of cases one see can be avoided to a limit... rather one can limit their work for some minimum number of cases for the sake of quality control( one of my colleague , turned greedier after starting working on these basis and ultimately turned into an escapist)

4. Please learn to say the golden words, "NO", " I CANT DO IT "..... It will save us alot from troubles.

AHAMAD MASTAN MUKARRAB said...

Ahamad Mastan Mukarrab I agree with you sir , but unfortunately in the present scenario of extreme commercialisation of radiology , numbers matter. You end up losing your job if you work too much on a single case with other colleagues just finishing off the norm...al ones tactfully. Most of the diagnostics centres / hospitals have a good marketing team whose only strategy is to increase the numbers , meet the targets etc etc, beyond the scope of this discussion. It is extremely painstaking to see the whims and fancies of such organisations who think thay are justyfying the so called business of radiology. I do agree that multilevel marketing , cut/referral fees etc have changed the economics of radiology , but I have serious concerns for such organisations whose suomoto is to capitalise on radiology.Fortunately in the predominant fraternity of so called " capitalist radiology "organisations there are few good charitable hospitals with a preamble to serve the poor and needy at reasonable prices. Kudos to you for bringing such a topic for discussion , If everyone of our radiologists take a strong resollution to curb this social evil with emphasis on service oriented radiology whisawis commercialisation, We can set apath for good radiology practise.Which institution teaches us that you are not a successful entrepreneur if you practise good radiology.It times for introspection and do our bit to curb the dragon of so called commercialisation. I hope this discussion will invite good thoughts from our very own radiological community, thanks sir. dr.mukarrab.

Sumer Sethi said...

@ Dr Haider I agree it is an ethical issue
@ Dr Karunakaran idea of dividing modalities for the day is excellent , there cn be no escape like this
@ Ahamad lets hope people see sense soon and look towards a quality radiology practise not just commercial.

Sumer Sethi said...
This comment has been removed by the author.
DR P K SINGH said...

Dear DR Sethi, I also faced similar episode that another radiologist working with me do like this but it helped me get better reputation. Only complicated cases are discussed by treating doctor so after few months i got better reputation in market. Another same is that a technician came to me for reporting some mri only complicated cases when his working radiologist is out of station and rest of cases are reported by technician only. But the other side of tel-eradiology is that while i am working full time at mri centre teleradiology keeps on contacting owners who are businessmen that we will report mri and ct scan at lesser rates as compared to your existing radiologist who is delicately working there for years and as a result of this in stead of annual increment owners didn't increase the payments because of tele-radiology.

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