Why does radiology have to be difficult?

“When angry, count to four. When very angry, swear.”
~Mark Twain

With orthopaedics being a high volume user of radiology, you would think that they wouldn't give you such a hard time when ordering studies. I understand that I am in an academic center and other services have residents calling for studies without an attending even seeing the patient. But, that is not how I roll. So, today I had to lay the smack down on a attending radiologist. When another service disrespects my residents, it makes me go volcano. So, here's the brief story.

I was minding my own business when 2 dudes ... oh sorry, that's a trauma story. Let me start again.

I am in clinic seeing my usual Monday morning 35 patients. I have a patient come in with a complaint of one foot problem (foot turning in) and we find another problem (probable PFFD). The mom is a poor historian and we have no charts from the outside hospital. On clinical exam, the patient just doesn't look right. He had dysmorphic facies and lower extremity anomalies. Something just wasn't right with this kid. We obtain the x-rays and realize that the other leg, which mom is not complaining about, has no hip. I further questioned the mother about his past medical history without any more information gathered. I thought about it and thought well how do I further evaluate this hip. I could do and MRI, Arthrogram, or an Ultrasound. Probably the least expensive and risky procedure would be an ultrasound. I ordered it and asked my nurse to see if it could be done today. I didn't think it would be such a big deal. Do the ultrasound and send the patient home with follow-up. Yeah, but no such luck.

As I go in and out of rooms, I hear my nurse trying to get things set up. There is some kind of back and forth. Then I hear they want to talk to the doctor. I said, OK; but my resident said he was all over is. I went into the next room. I come out again and my resident and nurse are saying how they don't want to do it because the kid is to old and they won't be able to see anything and yada yada yada. He gave one excuse after another. My resident said well Dr. P would like this done because it would be the most helpful and repeated what I had told him (this was confirmed by 2 others in the room at the time of the conversation). The radiologist said well I don't care what he wants, so forth and so on. (pause) "Oh no he didn't."

So, I walk over to radiology clinic. I walk into the reading area where 2 radiologists are reading films. I can't say everything I said. But, let's say if it was on TV it would have been bleeped out. I chewed him out for being rude to both my nurse and resident and for being a general @ss&*!#. The other radiologist got scatter from the fray as he tried to chime in on the case. I asked the just to do their f#%k!ng job and stop trying to act as if they are actually providing useful patient care. They should do the procedures they are asked to do like good technicians. In the end, I got my point across and the proper test was done.

Radiologists are like shadow merchants offering one expensive procedure after another and waffling on every diagnosis. They are like pathologists who need just one more stain or immunofluorescence to make the waffle diagnosis. Have some balls, make the call, and stop giving those who actually are taking care of the patients such a hard time.

"Anger is never without a reason, but seldom with a good one”
~Benjamin Franklin

PS. I actually have a lot of love for my radiology and pathology colleagues.