November 1, 2011

Let’s say it’s the middle of the night. Your teenager had complained of a headache earlier, but now he is in agony. Portland is too far; you rush him to a small hospital in your rural town, where the emergency department doctor orders a CAT scan. You wait patiently for the radiologist’s report.

While you drink bad vending machine coffee, a technician is running the CAT scan. When the test is finished, that tech sends the file to the radiologist on duty — on duty in Portland, that is.

The small hospital cannot afford to keep a radiologist on staff, so it outsources the job to another hospital or a teleradiology company. The radiologist there reviews the scan, writes up a report and sends the report electronically back to the hospital, where the treating physician reviews it and makes care decisions based on it.

The radiologist and the treating physician may never meet; indeed, they may never talk. The physician may have no idea where the test goes or who reads it, aside from the signature on the report.

In our current scenario, the physician may know the Portland radiologist, but he may not realize that the Portland facility is closed at this early hour, so the scan is automatically forwarded to a subcontractor. The subcontractor company is based in the U.S. a few time zones away, but the radiologists on staff aren’t physically there. They must be licensed to practice in Oregon, mind you, but they’re actually sitting in Hong Kong or Tokyo.

It seems farfetched, but this actually happened to a woman in Pennsylvania. The radiologist wrote the report, noting a mass in the woman’s head as well as a ring around the mass. The ER doctor reviewed the report but didn’t know what the ring meant (and he didn’t ask). He ordered the patient to follow up with an oncologist.

In fact, the ring was significant. It was an abscess, or buildup of fluid or pus in the brain. If left untreated, an abscess is almost always fatal — and, sadly, that proved true in this case.

The arms-length relationship between radiologist and treating physician is saving money for hospitals, but what is it doing for patients?

We’ll continue this in our next post.


Categories: Blog