Commodity or consultant? Clinical rounding tips the scales

As radiologists yield to pressure to generate more relative value units, the threat of commoditization grows and the opportunity to build consultancy skills lessens. A pilot study that paired a radiology resident with internal medicine teams on clinical rounds benefited physicians and patients.

The research, published online July 11 in Journal of American College of Radiology, painted a sobering picture of the status quo of the radiology profession. Radiologists have failed to focus on a “service first” ethic, which has promoted commoditization, according to Mark D. Mamlouk, MD, of University of California, Irvine, and colleagues.

“If radiologists are not ingrained during their training to be helpful consultants, they may learn when it is already too late,” wrote Mamlouk et al.

The researchers devised a pilot study that entailed a senior radiology resident rounding with several internal medicine teams for two weeks. The resident presented imaging studies to the team to review image appropriateness, protocoling, MRI safety and radiation exposure, and also reviewed the importance of including an adequate history in the image request process.

A survey administered to 20 clinicians post-rotation revealed:

• 90 percent strongly agreed that a strong clinician-radiologist relationship improves patient care; and
• 95 percent would want a future radiology resident to round with them.

When clinicians were queried about the similarity between imaging exams and lab tests, a question designed to elucidate issues of commoditization, 58 percent strongly disagreed or disagreed. But 32 percent neither agreed nor disagreed, and 10 percent agreed. “Thus, radiologists still have work to do to change this negative image of commoditization.”

Clinicians detailed other benefits of the project: streamlined patient care, avoidance of unnecessary exams and improved knowledge of radiology.

The radiology resident indicated the experience improved his consulting skills and understanding of clinicians’ perspective, and also facilitated camaraderie with clinicians.

Finally, the project built patients’ understanding of radiology and helped them realize radiologists are physicians.

Based on the pilot project, University of California, Irvine, may offer the 2-week rotation to other radiology residents.

The researchers noted the complex nature of the commoditization problem while emphasizing, “[Radiologists] who practice with a service-oriented mentality are less susceptible to becoming a commodity and possibly being replaced.”