Radiologists & Technologists — Building Effective Work Relationships
By Beth W. Orenstein
Vol. 11 No. 9 P. 12
You’re the technologist who performed the CT exam the radiologist is now interpreting. Having taken plenty of images before, you saw something unusual you believe should be communicated to the radiologist. Do you speak up or do you keep quiet because you’re the technologist, not the physician?
Leonard Berlin, MD, FACR, a professor of radiology at Rush University Medical College in Chicago and vice chairman of radiology at Skokie Hospital in Skokie, Ill., says he would most definitely prefer that the technologist speak up. “Technologists don’t read images,” he says, “but let me tell you, when they prepare studies for us to read day in and day out, they don’t become radiologists, but they do learn a lot about the images themselves. I have had technologists point out things to me that I may have overlooked. Sometimes it’s nothing and sometimes it is something. But I’d rather they speak up than something be missed.”
Berlin says throughout his years as a radiologist, technologists have noted issues in everything from routine hand x-rays to complicated CTs of the abdomen or chest. “I really appreciate their mentioning it even if I don’t think it’s anything because there have been those times when I might have otherwise overlooked what they were pointing out,” he notes.
Berlin’s response is just one example of the benefit of a good working relationship between technologists and physicians—both the radiologists reading and interpreting the exams and, in some situations, the referring physicians who ordered them.
“Certainly technologists are an invaluable component of any radiology practice, whether in a hospital or a private office,” Berlin says. “And in my many, many years in the radiology business, I can tell you, if it’s one thing I’ve learned, it’s that you have to get along with the technologists because they can help you do your job well or they can make life very difficult for you.”
Stamatia Destounis, MD, an associate clinical professor of radiology at the University of Rochester and a practicing radiologist and managing partner at the Elizabeth Wende Breast Care center in Rochester, N.Y., says in a breast-imaging center, the relationship between the technologists and the radiologists couldn’t be more important. In most cases, she explains, the technologists are the ones who have the patient contact, at least initially. Technologists must feel comfortable relaying to the radiologists any messages or concerns that the patients expressed or that they personally noticed.
“If a patient presents for a routine mammogram, [the technologist] is not going to examine her,” Destounis explains. “But she might say something to the technologist that is important to her care, such as she had a concern about a lump she felt or she noticed skin changes. The technologist also might notice something when positioning the patient for the mammogram, such as one breast feeling firmer than the other or a skin change. We’ve always encouraged our technologists to let us know about these things so we can best take care of the patients. It’s very possible that something may be palpable and not visible mammographically. There’s a lot we can and should do if the technologist alerts us to something. It may be nothing, but there also are many times it turns out to be something significant.”
To communicate potentially important observations, technologists can enter notes in the RIS, according to Destounis. Not only do the radiologists in her practice encourage the technologists to leave notes, they also give feedback to the technologists after the patient has been seen.
“When we do find something that the technologist has alerted us to, we go back and tell the technologists, ‘What you discovered was a cyst or a fibroadenoma.’” The technologists appreciate the feedback, and it reinforces their continued vigilance, Destounis says.
A technologist since 1994, Tammy Vervynckt, RT(R)(MR), team lead for MR and CT at Indiana Orthopaedic Hospital in Indianapolis, says she’s encountered both kinds of radiologists: “those who really put you on an equal playing field with them and are receptive to having you ask questions or point things out and those who you know don’t want to take anything from you.”
Fortunately, she says, most fall into the former category and know that if they treat the technologists with respect, the technologists will treat them likewise to everyone’s benefit—especially the patients. “When radiologists are respectful of us, we’ll go the extra mile for the doctor and the patient,” she says.
Confiding in Technologists
Berlin says another reason it’s important to create and maintain an environment of mutual respect between radiologists and technologists is because some patients feel more comfortable confiding in a technologist. The technologist may receive information that the doctors may never obtain because some patients feel intimidated by doctors, he says. If a patient confides in a technologist and he or she doesn’t pass the comments on to the radiologist, valuable information could be lost. “The doctor may never see the patient again and doesn’t understand why,” Berlin says.
Yet another reason to get along with technologists, Berlin says, is that bosses will go to the techs when they’re looking to find out about someone. When he was a resident early in his career, Berlin would moonlight in radiology, often filling in for vacationing radiologists. When the radiologist returned and wondered how the fill-in did, the first person he asked was the technologist, Berlin says. “If the technologist said, ‘My God, what a nice guy. He treated people well and treated the doctors well and his interpretations were good,’ I knew I’d be more likely to get a call back. But if the technologist said, ‘He was a real jerk,’ that’s the end. They can build you up and they can knock you down—sometimes with justification and sometimes without justification.”
To keep a good relationship going among the technologists at his hospital, Berlin recommends holding periodic meetings simply to talk. At his hospital, he says, there are monthly meetings where “we talk about this and that and open it up for discussion. If you create an environment and show the technologists you value their input, you’ll receive it.” How frequently a facility holds such meetings largely depends on the facility and its size, he says. Smaller facilities may not need as formal or as frequent meetings as larger institutions, he says.
Cathy Parsons, BS, RT(R)(M)(QM), FASRT, administrative director of medical imaging at Cumberland Medical Center in Crossville, Tenn., believes a good working relationship between technologists and radiologists begins with the technologists. “I think if the technologists are doing what they need to do and are providing good-quality images for the radiologists, the radiologists will see that they do good work, that they’re conscientious in their work, and will trust them.”
Parsons works with five radiologists and approximately 40 technologists at Cumberland Medical Center, and “the radiologists trust our technologists to get the best possible exam. Our facility is very fortunate in that our radiologists can work well with our technologists, but I’m sure there are facilities out there where conflicts exist.”
Parsons says it’s important for radiologists and technologists to remain friendly and work well together, but they shouldn’t become best buddies. “I can see where if you become best friends, it could get awkward, especially if the radiologist had to be critical of someone’s work or fix a problem,” she says. “It’s like any working relationship. You know about your coworkers and their families, but you learn to keep a certain amount of distance so you can have that working relationship and have it not be awkward. You can be nice and friendly and listen to family stories, but at the same time you still need to be professional enough so that if you need to correct them you can. There’s a fine line there that you need to walk.”
Vervynckt says she’s had relationships with radiologists where she talks to them outside of work and others where they keep to themselves “and you know it’s never going to be any other way. When I was in school, we went out with the residents a lot,” she says. “But since I’ve been out of school, I don’t have the relationships with radiologists outside of work. They know about our families and we know about theirs and major events in each other’s lives, but that’s about it.”
Vervynckt says it’s fairly easy to tell what kind of relationship you’re going to have with a radiologist because his or her personality seems to come out right away. “You can read them and see how your relationship is going to go. You can tell who’s receptive to being chit-chatty and who is all business,” she notes.
At Indiana Orthopaedic Hospital, Vervynckt says the radiologists reading images work off site, which can make it more difficult to talk to them than if they were in another room and “all you had to do [was] walk back and talk to them. It can make it a little harder if we’re in the middle of a study and need to talk to the radiologist right away about getting additional views or something like that.”
Destounis says her imaging facility has organized activities to promote good working relationships, including a picnic every summer where the technologists and the radiologists can bring their families and an employee appreciation dinner in the winter. It helps everyone get along and improves communication, she says. “But we also make sure that the relationships among employees are predominantly professional, as they should be. You don’t want to be buddy-buddy, but you need a close working relationship with the technologists so they know how you work and what imaging views you would want in certain situations.” She says the radiologists know “that you need your staff 100% behind you. [The staff are] your eyes and ears. You have to look at it like a partnership. In practices where that doesn’t happen, it doesn’t work out. You don’t want your staff working against you.”
In his position as technical director of radiology at Brigham and Women’s Hospital in Boston, Michael Delvecchio, BS, RT(R), is responsible for more than 235 technologists of all types and experience levels who serve more than 150 radiologists, excluding residents. He agrees that technologists and radiologists need to work as a team. He says radiologists must set the imaging standards and protocols for the procedures “and make sure their needs are met” with every study. At the same time, he says, the technologist must “advocate for the patient and obtain the information the radiologist needs to interpret the study and make a diagnosis.” Any additional information obtained from the patient is always valuable, he says.
“The technologists should always use the imaging protocols set by the radiologists but make sure to work with the radiologist so nothing is missed. It’s a mutual thing.”
— Beth W. Orenstein of Northampton, Pa., is a freelance medical writer and regular contributor to Radiology Today.