We need a revolution in radiology

I had a scan recently. Embodying the patient role always feels clunky, like I’m stuck temporarily on the wrong side of the fence, never sure if I should ‘fess up and declare my medical background. It also always seems to provide endless food for thought and opportunity for reflection afterwards about how the health service runs.

As she worked, my radiographer and I were chatting and during our discussion. She explained how the scan I was having was very unlikely to answer the question the requesting doctor had posed.

Another imaging modality would be superior, she relayed, and it was likely that I would need to go on to have another, more appropriate test. Although professional and polite, her frustration was plain to see. I got the feeling that the radiologist would have challenged the request if it wasn’t for the outdated hierarchical culture which is still commonplace in NHS institutions (the scan had been requested by a no doubt well-meaning senior doctor).

As I pondered afterwards, it seemed to me that maybe the ‘system’ had failed us all. Me, because I had undergone an inappropriate test which wasted my time and could potentially lead to harm in terms of incidental findings or risks from the procedure or a delay in diagnosis as I waited for another test. The radiographer was failed, as her skill and knowledge were redundant while she performed a test that she knew to be useless.

More broadly, the NHS as a whole was failed, as scarce resources had been used up by an inappropriate use of the service.

I’m sure that similar episodes play out daily across radiology departments up and down the country, leaving colleagues working there frustrated by requests for inappropriate tests.

Although perhaps it’s not all doom and gloom, certainly, in Birmingham where I was working during the pandemic, requesting tests became more highly regulated and clear guidelines about what should and what shouldn’t be scanned were issued.

In addition, advice telephone lines were set up allowing GPs direct access to have discussions with a senior radiologist. I suspect these interventions have helped to improve the quality of referrals sent from general practice.

To be clear, I’m not assigning blame to the diligent GPs who are making decisions to the best of their abilities. I’m simply considering that there might be a better way of getting the right scan for the right patient. Is the current request system flawed?

We have teams of highly qualified radiologists and radiographers – professionals who are skilled in knowing which scan will answer which clinical question. Why on earth are other clinicians choosing which imaging modality to order for their patients? The clinicians themselves are also experts – in clinical assessment and generating clinical questions. Why don’t they simply pose their clinical questions to the radiology team who can then book the appropriate imaging? Too simple?

Furthermore, would such a system also provide opportunity for better collaboration and communication between general practice and radiology teams? Would it not lead to each specialty better understanding and valuing the others’ unique contribution, allowing them to forge a new way of working together to do the very best for their patients?

In an ideal world, perhaps each PCN could have links to a specific radiologist or radiographer as a point of contact to maximise the success of such a system. Could we improve care by ensuring that everyone within the system focuses on the things that they do best?

Dr Lisa Finnikin recently stopped working as a salaried GP in Sutton Coldfield. Details have been changed to protect confidentiality