Clinicians versus radiologists

This is purely from my experience, after 4 and a half months of being at the bottom of the pyramid of the professional caste of medicine.
The clinician and the radiologist – both possible future options for housemans and med students. First of all im really thankful i’m in medicine...there are so many possible choices for my career in the future...i feel like the little zergling worm that gets to become anything from a giant flying alien crustacean to a living disgusting zergling factory/fortress to a superunit in starcraft..
Anyway these two species rarely meet in this diversely intercorrelating small environment called a hospital..but both are crucial, like so many other aspects, in the treatment process of the patient..the central subject of our work.
So how do they interact? That’s where we house officers come in...our role as messengers have been embedded deeply into the programme called housemanship I’m supposedly “enjoying” right now. I dont mind having to go down every now and then, read up on the way (especially when it’s not my case- sometimes), and try my best to convince the ever-so-busy radiologist that this is an urgent and necessary intervention. But in some things,as with everything in this world, they are always at odds with their idea of what is urgent and what is not.
One “urgent” request i never could get urgently was the “urgent ct neck,thorax,abdomen and pelvis for staging”. I know, both parties have reasons why it is’nt/is urgent.
The clinician/specialist/mo wouldn’t want this ct study too late, as the earlier the cancer is treated, the higher chances of the 5year survivability rate..letting the patient go home first, take the scan a few weeks later, then deciding what kind of treatment is simply unacceptable in their minds..i tried to talk the out of it, but who listens to the houseman right? Some common replies from my pleas of not wasting my time in (in my opinion) a futile attempt to get the radiologist to do it on the same day of diagnosing the cancer was “of course it’s urgent. Are you nuts?” or something like that, or something along the lines of “why wouldn’t they accept it..it’s stated right here (shows the previous scan and/or u/sound) that they were the ones who suggested it”
After those brief conversations, the houseman/peon takes out his pen, dishes out the forms,carbon paper, etc, gets the specialist countersign, and prepares himself for the impending encounter with the radiologist downstairs..(on a good day, that certain HO even believes in his heart that this will work,and those helpful tips he got from the specialist/mo would prove fruitful)
He gets to the scan room, clears his throat, and does his best to impress on the radiologist the urgency of doing this.
Deep down, he knows why the radiologist would’nt want to agree..here’s a list:-
• There is no urgent or life-saving procedure no matter what the outcome of the scan (unless it’s a primary cancer- which is usually a coincidental finding or after routine screening, and without clinical symptoms already)
• Urgent for them means the patient’s life is in danger and severe permanent outcomes would happen if they didn’t do the examination helping in the decision for the course of treatment
• They would have to put aside extra time to check almost all the systems from the neck to the pelvis- precious time needed to finish their scheduled scans and reports before the clock turns 5.this might sound a bit selfish, but they do have a lot of work, and like everyone else in the hospital, they manage their time the same way – they prioritise.
So what’s my point?unfortunately i can’t recall another “mission impossible” task of urgent special examinations...but this one is clear, and the point is I hated whenever this examination comes up, because it would mean me wasting my time going down and up, sometimes multiple times, trying to get something they’ll never agree upon –maybe they would, when-um- stretchers learn to fly or something..
Dont get me wrong, i’d take a ct brain urgent TRO ICB or US KUB urgent TRO obstructive uropathy or any other necessary tests that requires urgent intervention any time and help save that poor patient’s prognosis. Especially when u get all the facts/reasons right, and everyone agrees it’s urgent.
The bottom line- why wouldn’t they just tell me to get a really-really early appointment, we’ll decide the date (usually within 1-2 weeks) and readmit the patients like how the nephro team does, and decide the treatment..as what usually happens anyway (actually, they get a TCA ward first, and THEN the MO would decide to admit the patient to start chemo, or to refer to ghkl or any other oncological department in Malaysia) instead of telling me to fight over something the other party would never see. Come on guys..agree to disagree..and cut the chase..at the end of the day i’d still learn something anyway...but with way less time and effort wasted
And here is the rest of it.