“Common sense is a superpower”

“Common sense is a superpower.”

This throwaway remark, by an Australian academic general practitioner during a seminar at the Preventing Overdiagnosis conference in Copenhagen in August this year, really got me thinking.

I’m sure he says it often at such meetings, and most listeners ignore it, but for me it was a light-bulb moment. To a proportion of my radiology colleagues, it is a good estimate that at least 50% of the imaging we do in the UK is unnecessary.

To a proportion of the clinicians who refer cases to us, meanwhile, it is clear that too many scans are being done.

So when I receive what I think is a dodgy referral and phone the clinician responsible, I appreciate that often, in the absence of any good evidence base for not doing a particular test, I am appealing to their common sense. I’ve been doing this for many years.

There are colleagues, senior and junior, who immediately get what I’m saying, agree with my point before I’ve even finished, and cancel the pointless test.

There are others who will justify their request based on some misguided notion that they must rule out the tiny possibility of some rare and life-threatening condition, with huge medicolegal ramifications if they get things wrong.

With these people, we might as well be speaking a different language. We are never going to agree, and they will forever view me as being unnecessarily difficult.

Similarly, there are radiologists who, as I do, despair about the 10% annual increase in scanning demand and the huge rise in out-of-hours scanning. Yet others seem not to question whether what we’re doing makes any sense.

They want to buy more scanners and employ more staff. Yet the most recent Royal College of Radiologists (RCR) census shows how workload has increased without a commensurate increase in staffing.

Dr Nicola Strickland, the president of the RCR, rightly bemoans the gap between the numbers of applicants and funding for radiology posts in the UK. There is an estimated £116m spent on outsourcing that could be diverted to training and employing more radiologists.

This is not to say outsourcing is bad. The position of medical leaders in UK teleradiology is and always has been that there is a demand for outsourcing, and we should try to meet that demand. However, it needs to be treated with common sense.

Some client departments know this: they have tight control of job plans, using their own radiologists and reporting radiographers flexibly to maximise productivity, and plan their outsourcing in advance.

The most sensible departments even have a radiologist whose role it is to guarantee value for money.

However, others will phone teleradiology providers the week they have a problem, wanting to throw work at us with a tight turnaround time when teleradiology capacity is also low.

Teleradiology providers have been accused of cherry picking when they turn down this unexpected workload. The truth is that the medical leadership of all teleradiology departments would welcome a common-sense approach to the use of their services.

Through the TMC Academy, Telemedicine Clinic has offered to work with the RCR to contribute to educating the radiologists of the future, helping to increase trainee numbers more cost-effectively.

With better-staffed departments, TMC would then provide strategies to balance any outsourcing against local demand and capacity, reducing dependence on its services to a responsible level and allowing it to support departments more effectively.

When I read the annual RCR census and the commentary on it which reaches the national press, I am proud of my college for collecting and publishing such robust data, but I am always disappointed that the appropriateness of this huge increase in imaging is no longer challenged.

The big message from the College is that more and more money is wasted on outsourcing, and that it could be better spent. The implication is that outsourcing companies are a financial drain preventing the appointment of local radiologists.

In contrast, I’m convinced that if client departments were encouraged by the College to work closely with teleradiology suppliers to better manage their own capacity and control demand, as we already do out-of-hours, we could reduce dependence on outsourcing reports.

If we can harness this superpower called common sense, and teleradiology companies’ wide-ranging expertise is exploited, we can reverse many of these worrying trends.

– George McInnes

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