Handling the Phone Calls
· Do not discuss doing studies with nurses or ward secretaries. Tell them that the ordering physician needs to call you--no exceptions. If the intern or resident that you're talking to doesn't seem to know the details of the situation (which happens), ask to speak with the person who really wants the exam done (e.g. the consulting service, the chief resident, or the attending).
· Emergent, semi-emergent, and even questionably emergent studies requested by clinical faculty should be done without much resistance. Only totally routine exams that faculty request should be deferred until the next business day. Any potential conflicts should be immediately routed to radiology faculty for a staff-to-staff discussion.
· Due to differences inherent to their level of experience, clinical housestaff are more likely to order inappropriate studies on call. As a radiology resident, you have more experience in evaluating what are appropriate indications for radiologic studies. Don't hesitate in offering to change, modify, or delay requests so that the right studies are performed by the most experienced operators.
· As a general rule, we do not have resources available (resident manpower, techs, sedation nurses) to perform non-emergent procedures and special studies after hours. The trick is in conveying this idea to clinicians in a tactful way. If a non-emergent study has been requested, it often helps to offer some other solution, such as scheduling the procedure for the first thing in the morning (but be sure to do it) or trying an alternative modality such as CT instead of ultrasound. Again, if there appears to be a major conflict brewing, the clinical and / or radiology staff should be brought into the discussion.
When asked to perform a special procedure on call, be sure to obtain the following info from the clinician when you first talk to them: