Is it ethical to add to referring physician's order?

Valid question raised in AJR February 2013 vol. 200 no. 2 W216, which questions if radiologists should or could add to the request if they feel added study will be required in the said case. Although, it sounds perfectly ok to proceed and help the patient as much as possible but does it make sense considering the reimbursement rules. Shouldn't radiologist be the person to decide on the required investigation even for reimbursments? Or the referring physician will rule over this for the time being?

What are your thoughts and comments on this?

Some of the comments so far on this debate on facebook page:

Radiologist 1::  the radiologist can give advice and indicate why.....the physician can take the final call!

Radiologist 2 : Good interdepartmental communication can sort it out.. such decisions need imputs from both sides

Sumer Sethi yes, but in a pvt stand alone diagnostic practise, how do you you sort it out. and what are the rules for reimbursement if patient is an insurance patient.

Radiologist 2 ::  I think it has to be clinician's call

Sumer Sethi even if he advised USG Pelvis for appendicitis, or he advises CT where MRI should be done or vice versa. Why should it not be just an imaging referral, where we decide what we need to do?

Radiologist 2 ::  its all because of severe lack of knowledge prevalent in india..we can advise the clinician..but i dont think we should change it if clinician is adament...in such situations, i simply advise the investigation that is required in the report


Sumer Sethi agreed, but the problem is in the end patient is the "looser", why cant we radiologists increase our role from just passive followers to more active advisers as well.

Radiologist 2 i feel such decision making by radiologists alone is not valid..may be clinicians should be legally bound to be knowing wat to advise and listen to our advise..i being in institution actually do not often face such problems.. we as radiologists always try to advise wat needs to be done.. but wat can we do if clinican is unwilling to acccept the advise. wat do u do in such a situation?
about a minute ago · Like

Sumer Sethi That is exactly my question, when someone tells me to do a CT for epilepsy in a child and he says he wants CT as it is better than MRI in this case- may he shud be bound to listen to us here??

Radiologist 2 the problem is clinicians r supposed to know it and they dont.. and its really gray area..actually who do not know this much hav not right to advise such investigations in first place..we never see a neurologist or neurosurgeon doing this


Radiologist 3 I agree with Sumer Sethi, the radiologist should take the final call. many times, we see completely inappropriate investigations are ordered, which we know are not gonna help the patient.