Radiology, Family Medicine Urged to Strengthen Ties

In a joint presentation at RSNA 2009, Carol Rumack, M.D., and Robert Bales, M.D., stressed the need for cooperation between radiology and family medicine.

Interspecialty cooperation between radiology and family medicine is critical if patients are truly to benefit from both, according to the presenters of an RSNA 2009 refresher course, "Radiology and the Family Physician."

Primary care doctors must learn to work better with all specialties, but especially radiology, said presenter Robert Bales, M.D., an assistant professor of Clinical Family Medicine at the University of Illinois College of Medicine in Rockford.

While many areas of medicine, including radiology, focus on depth of knowledge, family medicine is all about breadth of knowledge, said Dr. Bales, who follows the guidelines of the American Academy of Family Physicians' Patient Centered Medical Home.

For example, Dr. Bales offers patients evening and weekend hours to accommodate their busy lives and has even been known to make a house call. "I love what I do—doing mental gymnastics in caring for patients across the spectrum of life," he said.

Dr. Bales said his practice is shifting from paper and written prescriptions to electronic health records and e-prescribing. He uses electronic evidence-based decision making to help decide which tests and procedures his patients should undergo, always asking, "Is there a better test to diagnose this condition?"

"I want to get the results fast—not in two weeks. Sometimes you just have to pick up the phone and call the physician who conducted the test," said Dr. Bales. "That will never go out of style."

Recent studies have shown patients with primary care providers spent 33 percent less on healthcare and have 19 percent lower mortality rates than their counterparts without primary care doctors, said Dr. Bales.

Moving Toward Patient-Centered Care

Presenter Carol Rumack, M.D., said there has been an interesting paradigm shift. "We need to put the patient in the center of care," she said.

PACS have contributed to the further separation of patients and radiologists, said Dr. Rumack, a professor of radiology at the University of Colorado Denver School of Medicine and president of the American College of Radiology (ACR).

For the past five years, RSNA has supported the "Patient-Centered Radiology" program and ACR launched a "Face of Radiology" campaign—both aimed at engaging radiologists in patient interaction with the ultimate goal of improving patient care. "This is what we would want for our own medical care," she said.

To increase face-time with patients and their families, Dr. Rumack makes clinical rounds twice a week with a neonatologist in her hospital's neonatal intensive care unit (ICU).

She talks daily by phone to faculty and residents about each patient's care, conveying any critical information. When performing ultrasound procedures with the family present, Dr. Rumack makes sure they understand the findings and what they will mean for the patient's prognosis. The neonatologist is there to explain the next step for the patient if necessary.

"During my early training, we were told to send parents out of the room when conducting an ultrasound on babies and children," Dr. Rumack said. "Technicians and nurses taught me that children would be much more cooperative if their parents were in the room. That made it easier to check the children and it gave me the chance to have direct patient contact."

Another way to get to know other doctors is by participating in hospital committees and operations. "As I like to say, let's get out into the light," she said. "Getting involved in the delivery of patient care gives us a chance to be sure that diagnoses are made quickly and with full knowledge of critical issues."

RadiologyInfo.org Connects Doctors, Patients

She recommends patients visit RadiologyInfo.org, the public information Web site developed and funded by RSNA and ACR, that offers a better understanding of radiologic procedures, the indication for those exams and what the equipment looks like. It is written in language the patient can understand—in other words, without doctor-speak.

Drs. Rumack and Bales said it is a good idea for patients to receive any bad news from both the primary care physician and the radiologist. While interventional radiologists and radiation oncologists have many more opportunities to work directly with patients, Dr. Rumack said it's time for diagnostic radiologists to get on board. One way is by encouraging residents to interact more with the referring physicians and patients in the community.

"We need to be visible by meeting patients and discussing medical results with them," she said. "It is important for the patient to know that the radiologist is also a physician so that we don't hear, 'Oh, you don't fix radios?' from patients," she said to laughter from the audience.