Kevin Pho is predictably outraged:
An ordering physician always needs to take responsibility for the results of the test, even if it doesn't fall under his specialty.
I get it. Another overpaid proceduralist neglecting to take care of anything other than making sure the lucrative procedure gets done. But let's take a moment, shall we? Do we really believe that some urologist is going to be the one who coordinates the appropriate follow up for an abnormal chest X-ray? A urologist? God help us all if that's the honest solution.
As a surgeon, I send all my elective patients for pre-operative testing. This usually involves some combination of blood work, an EKG, and sometimes a chest X-ray. The determination of what is needed is often left up to the pre-testing center, the primary care doctor, and the anesthesiologists who will be doing the case. On the day of the surgery I glance through the chart, make sure everything is copacetic, and then we proceed. Sometimes the lab will call a few days prior to surgery with an abnormal value and I will look into it dutifully. I'll be honest; I don't pay much attention to a CXR report unless I'm specifically concerned about something beforehand (patient with COPD, hsitory of lung resection etc). Sometimes the official report on the CXR doesn't end up on my desk until a week after the procedure has already been done. But my name is on the CXR and I have to go through a pile of reports every couple of weeks. If anything jumps out, I will contact the PCP.
So who is responsible for an abnormality on a pre-operative CXR? What is a surgeon/orthopod/urologist supposed to do if they get a CXR report on their desk a few weeks after operating on someone (whom they barely remember) that states something along the lines of "right lower lobe mass, well circumscribed, 1.1 cm, clinical correlation/follow up images recommended"?
What about the DOCTOR who actually provided the expertise in reading the image? I know it's outlandish to expect a radiologist to (heaven forbid) actually interact with a patient over the telephone, but is it really that unreasonable to expect a specialist to follow up with the consequences of his/her determinations? If a family practice doc refers a patient to me for an abnormal mammogram and I see the patient and recommend a stereotactic biopsy, whose responsibility is it to make sure that biopsy gets done? Ought not the surgeon, the ostensible expert, assume the primary burden?
For some reason radiologists are immune to the usual expectations of physician responsibility. It must be nice to just have to dictate an addendum in your report about "follow up" and "clinical correlation" in order to exonerate you from all future culpability. A subtle liver or lung lesion gets passed off to the "ordering physician". Because you can't expect a radiologist to care about what happens to patients whom they have been consulted to provide radiologic expertise on, right? Right? Am I missing something here?
Someday, we will have a national data base of patient information via a centralized EMR and concerning lesions on routine screening films will get red flagged automatically. Until then, shouldn't we be able to trust that the physician who deems such lesions as "concerning" will be the one who is in the vanguard of doctors who make sure that said lesion is addressed properly?