Would you prefer your own cancer scan to be reported at a radiologist's home or within the hospital? It was a simple question, but it recently ignited an impassioned debate. As home working becomes more common, this question raises important issues and lies at the heart of how radiologists will work in the future.
The flexibility of home working is a major reason why some radiologists are happy to sign up with teleradiology companies, according to Dr. Neelam Dugar, consultant radiologist and clinical PACS lead at the Doncaster and Bassetlaw Hospitals in the U.K. Radiologists need to be in the hospital for certain tasks, but there are elements of their practice where they can just be reporters based at home, and technology assists here, she added. Often, however, hospital managers are unhappy when radiologists even suggest the idea of home working.
"We need to move on, we need to change the culture within the NHS [National Health Service], and we need to get the additional capacity," she said during the outsourcing debate at the 2015 U.K. Radiological Congress (UKRC). "Why can't the NHS get its act together and allow workers to do one or two sessions from home?"
This notion was challenged by broadcast journalist and specialist news reporter Krishnan Guru Murthy, who moderated the UKRC session.
I don't want my cancer scan to be read while your children are screaming at you, Krishnan Guru Murthy said."But you would then spend even less time in the hospital... So basically you want to work two and a half days in the hospital and still get paid full-time?" he retorted. "As a consumer of the NHS, I don't particularly want my cancer scan to be examined while your children are screaming at you for food and attention."
A radiology registrar, or junior radiologist, then got an enthusiastic round of applause from the packed hall when he explained why his clear preference was to work at home.
"I would prefer to be at home reporting, even with my children screaming at me, compared to the way I am working in the hospital," he said. "I am the lone person, reporting scans from four hospitals, including at night, dealing with important cases like stroke and accident patients and patients with serious abdominal conditions, and I am constantly being interrupted by phone calls from those hospitals. My child crying might sometimes be an amusement to me, rather than an interruption."
Home inspections
Outsourcing companies have a key role to play here by inspecting the radiologist's home environment when they install a workstation, according to Dr. Stephen Davies, medical director of teleradiology firm Medica. He said he wrote the Royal College of Radiology's (RCR) standards covering this area in 2006, and these standards have subsequently been revised by a group headed by Dr. Nicola Strickland at London's Hammersmith Hospital, so a lot of information is available about ergonomics.
Outsourcing companies must inspect the radiologist's home when they install a workstation, according to Dr. Stephen Davies.Furthermore, other quality control procedures and safeguards exist. For instance, Medica monitors regularly audit around 10% of examinations, and the firm provides supplementary training when necessary and will undertake a secondary assessment of a radiologist's home environment if there has been a problem.
"Please be aware these radiologists are our colleagues. You're suggesting they perhaps have double standards in that they care about their working environment in the NHS, but when they get home, they're really not too bothered," he told UKRC delegates. "We need to be very careful here."
One of the session panelists was puzzled about why radiologists appear to be so keen to work at home at all.
"What I still don't understand is: what is the obsession with radiologists reporting from home?" asked Pam Black, chair of the U.K. Council at the Society and College of Radiographers and a radiology services manager at Wirral, Merseyside. "Why do you want to sit at home all day reporting?"
No radiologists on site?
She suggested that hospital managers could quite easily run a radiology service without any radiologists onsite by contracting with them to report from home and bringing them in for multidisciplinary team meetings or consultation sessions. "But that's zero contracting," Black warned. "If you carry on like this, that's what's going to happen. It's as simple as that."
Alongside this, not enough is being done to develop radiographer reporting -- and radiographers aren't going to report from home, they're going to sit in the hospital and do it, she added.
Given the shortage of radiologists in the U.K., the real issue is not whether patients want their cancer scans to be read at home, but whether they want them to be reported in a timely manner with an appropriate clinical governance framework and an audit background to ensure accuracy and a low error rate, according to a UKRC attendee who did not reveal his identity. The alternative is to see the scan disappear into a huge melting pot, where it may or not be reported, he emphasized.
"We have radiologists who are working hard during the week, doing on-call, and yes, they are going to be less productive, not just the next day but also the next week," he said. "If you now cover an on-call weekend, having worked a full week, then you are not going to be productive."
Preventing burnout among radiologists is a prime concern of RCR President Dr. Giles Maskell.
People retiring at 55 is disastrous, said Dr. Giles Maskell."We need to look after the radiologists we've got and make their working lives less stressful and less subject to burnout and all the other adverse health risks," he commented. "We see people retiring at 55 or 58, and that's disastrous. We need to keep that resource."
He believes outsourcing and teleradiology should be part of a short-term solution for the U.K., along with recruiting more radiologists from overseas, but the long-term answer is to train more radiologists.
Another factor to consider is that radiologists tend to be more productive when they are working outside of their allocated hours, according to Dr. Andrea Howes, consultant radiologist at St. Helens and Knowsley Hospitals NHS Trust.
"Occasionally, if we are struggling for capacity, I will stay for an extra hour and pick up some plain films or something. I am far more efficient in that extra hour, when phones aren't going and people don't think I'm there, and when I'm not being asked if I can vet this form or come and look at this scan," she stated.
