APDR_professionalism_module_2011

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					                The Resident as a
                Professional in Radiology
                 Self-Learning Module
Association of Program Directors in Radiology (APDR)
Alliance of Medical Student Educators in Radiology (AMSER)

                                          Andrea Donovan, MD
                                          Sravanthi Reddy, MD
                                          Christopher Straus, MD
                                          Petra Lewis, MD
                                                       APDR Resident Professionalism Module   2




This module is designed for radiology residents. At
the completion of this module, the participant will be
able to:

    • define professionalism elements in medicine
    • apply these elements to radiology scenarios




disclosure of commercial interest
The authors are not aware of any commercial interest
or any conflicts-of-interest with regard to this
resident learning module.
                                                     APDR Resident Professionalism Module         3




                                                                                       module start



Module outline                                                                                pretest



    1. pretest                                                                       professionalism
                                                                                         in medicine

    2. professionalism in medicine
    3. professionalism in radiology                                                  professionalism
                                                                                         in radiology

         • skills and standards / intro, cases, questions
         • behaviors / intro, cases, questions                                                  skills

         • service / intro, cases, questions
    4.   posttest                                                                           behaviors



                                                                                              service



                                                                                             posttest

           Use the panel on the right to navigate between sections
                                                APDR Resident Professionalism Module         4




                                                                                  module start



                                                                                         pretest


1.   Pretest
                                                                                professionalism
                                                                                    in medicine


      Please answer the following five questions related to                     professionalism
      case scenarios. Write down your responses.                                    in radiology


      The same questions will be asked at the conclusion                                   skills
      of this module, with correct answers and
      explanations provided.                                                           behaviors



                                                                                         service



                                                                                        posttest
PRETEST                                                APDR Resident Professionalism Module         5




                                                                                         module start

    1. Your 10-year-old daughter is a patient at your medical
    center. Are you allowed to access the electronic medical                                    pretest

    record to check her x-ray results?
                                                                                       professionalism
                                                                                           in medicine



          A.   Yes, because she is your daughter                                       professionalism
                                                                                           in radiology

          B.   Yes, because she is under 16
                                                                                                  skills
          C.   No, because you are not her physician
          D.   No, because she has not given written consent                                  behaviors



                                                                                                service



                                                                                               posttest
PRETEST                                               APDR Resident Professionalism Module         6




                                                                                        module start

    2. A sales representative from a leading CT manufacturer
    gives you a laser pointer labeled with the company name.                                   pretest

    Can you accept this gift?
                                                                                      professionalism
                                                                                          in medicine


          A.   Yes, because its value is <$50
                                                                                      professionalism
                                                                                          in radiology
          B.   Yes, because you are not buying their equipment
          C.   No, as it is labeled with the company name                                        skills



          D.   No, as gifts should not be accepted from                                      behaviors

               commercial companies
                                                                                               service



                                                                                              posttest
PRETEST                                                  APDR Resident Professionalism Module         7




                                                                                           module start

    3. An attractive patient flirts openly with you during an
    upper GI study. How should you react?                                                         pretest



                                                                                         professionalism
                                                                                             in medicine
          A.   Refuse to have any further contact with the patient
          B.   Tell the patient you are not interested and to stop                       professionalism
                                                                                             in radiology

               flirting
                                                                                                    skills
          C.   Include a chaperone at future meetings and if it
               continues inform your attending                                                  behaviors

          D.   Make a date to see him/her after you are off the
               service                                                                            service



                                                                                                 posttest
PRETEST                                                 APDR Resident Professionalism Module         8




                                                                                          module start

    4. You are on call with a radiology fellow and you
    smell alcohol on his breath. How should you manage                                           pretest


    this situation?
                                                                                        professionalism
                                                                                            in medicine


          A.   Ignore it as he does not appear drunk
                                                                                        professionalism
                                                                                            in radiology
          B.   Confront him with your suspicions
          C.   Call the attending on-call that night                                               skills



          D.   Talk to the residency director the next day                                     behaviors



                                                                                                 service



                                                                                                posttest
PRETEST                                              APDR Resident Professionalism Module         9




                                                                                       module start

    5.  Can you use patient images for a presentation at a
    national meeting?                                                                         pretest



                                                                                     professionalism
                                                                                         in medicine
          A.   Under no circumstances
          B.   Only if you sign a waiver                                             professionalism
                                                                                         in radiology


          C.   If the patient signs a waiver
                                                                                                skills

          D.   If the information is de-identified
                                                                                            behaviors



                                                                                              service



                                                                                             posttest
PROFESSIONALISM IN MEDICINE                                    APDR Resident Professionalism Module        10




Professionalism in Medicine
                                                                                                 module start



                                                                                                        pretest


               “Professionalism is the basis of
                                                                                               professionalism
               medicine’s contract with society”                                                   in medicine



                                                                                               professionalism
                                 Ann Inter Med 136:243, 2002                                       in radiology



                                                                                                          skills

             when professionalism is absent
                       • patient care suffers                                                         behaviors



                       • the work environment is degraded                                               service

                       • medical errors increase
                                                                                                       posttest
PROFESSIONALISM IN MEDICINE                            APDR Resident Professionalism Module        11




                                                                                         module start



                                                                                                pretest



                                                                                       professionalism
                professional                                                               in medicine


                a person who uses specialized skills in the                            professionalism
                service of others, conforms to the technical                               in radiology

                or ethical standards of a profession, and
                                                                                                  skills
                exhibits a courteous and conscientious
                behavior
                                                                                              behaviors



                                                                                                service



                                                                                               posttest
PROFESSIONALISM IN MEDICINE      APDR Resident Professionalism Module        12




 Challenges to professionalism                                     module start



                                                                          pretest



                                                                 professionalism
                                                                     in medicine



                                                                 professionalism
                                                                     in radiology



                                                                            skills



                                                                        behaviors



                                                                          service



                                                                         posttest
                                                  APDR Resident Professionalism Module        13




                                                                                    module start
radiologists face additional challenges because
of the specialized nature of their practice                                                pretest



                                                                                  professionalism
  •   infrequent contact with patients                                                in medicine



  •   infrequent contact with clinicians                                          professionalism
                                                                                      in radiology



                                                                                             skills



                                                                                         behaviors



                                                                                           service
                                  Residents on radiology rotations
                                  may also face the challenges of
                                  insufficiently defined roles.                           posttest
PROFESSIONALISM IN RADIOLOGY                                APDR Resident Professionalism Module        14




  professionalism in radiology demands                                                        module start

  commitment to established standards of:
                                                                                                     pretest



                           professional competence                                          professionalism
      skills               scientific knowledge
                                                                                                in medicine



                           improving quality of care                                        professionalism
                                                                                                in radiology

                               professional responsibilities
      behaviors                honesty with patients                                                   skills

                               patient confidentiality
                                                                                                   behaviors
                               appropriate patient relationships

      social justice                improving access to care                                         service


      & service                     just distribution of finite resources
                                                                                                    posttest
                                    managing conflicts of interest
PROFESSIONALISM IN RADIOLOGY / SKILLS                APDR Resident Professionalism Module        15




                                                                                       module start
 1.   professional competence and scientific knowledge
                                                                                              pretest




      individual                                                                     professionalism
                                                                                         in medicine

      commitment to
                                                                                     professionalism
       • lifelong learning                                                               in radiology


       • creation and spread            medical community                                       skills
         new knowledge                  commitment to
                                        • high standards                                    behaviors


                                        • rigorous assessment of                              service
                                          member competence
                                                                                             posttest
PROFESSIONALISM IN RADIOLOGY / SKILLS                APDR Resident Professionalism Module        16




 2.   Improving Quality of Care
                                                                                       module start



                                                                                              pretest
              clinical competence
              ongoing process through                                                professionalism
                                                                                         in medicine
              professional career
                                                                                     professionalism
                                                                                         in radiology




                         collaborative work                                                     skills



                         • reduce medical error                                             behaviors

                         • increase patient safety
                         • maximize resources                                                 service


                         • optimize outcomes
                                                                                             posttest
PROFESSIONALISM IN RADIOLOGY / SKILLS                    APDR Resident Professionalism Module        17


Commitment to Improving Quality of Care
                                                                                           module start



                                                                                                  pretest



                                                                                         professionalism
        effective collaboration is essential, and involves                                   in medicine



         •   accessing clinical information on a patient                                 professionalism
                                                                                             in radiology
         •   timely reporting of critical findings to clinician
         •   clear noting of discrepancies in on-call report                                        skills


         •   thorough documentation of all communication
                                                                                                behaviors
             with clinicians in patient record
                                                                                                  service



                                                                                                 posttest
PROFESSIONALISM IN RADIOLOGY / SKILLS                   APDR Resident Professionalism Module        18




case
                                                                                          module start
 1       While you are on MSK rotation, the ED physician
       requests a CT of the foot in a diabetic patient to rule out                               pretest

       osteomyelitis. What should be your next step?
                                                                                        professionalism
          A.    Approve and schedule the exam                                               in medicine



          B.    Refuse to perform the exam                                              professionalism
                                                                                            in radiology

          C.    Refer to the ACR Appropriateness Criteria®
                                                                                                   skills
          D.    Ask if the patient had foot radiographs already
                                                                                               behaviors



                                                                                                 service



                                                                                                posttest
PROFESSIONALISM IN RADIOLOGY / SKILLS                          APDR Resident Professionalism Module        19




case
                                                                                                 module start
 1      correct answer is “C”
        refer to the ACR Appropriateness Criteria                                                       pretest



         Before accepting a consult, confirm that the imaging                                  professionalism
                                                                                                   in medicine
         test is appropriate. If you are unsure, refer to the ACR
         Appropriateness Criteria®.                                                            professionalism
                                                                                                   in radiology



         You also need to be aware of relevant clinical history                                           skills

         including allergies, labs and contraindications to
         imaging tests.                                                                               behaviors



                                                                                                        service



                                        The uncritical use of high-tech medical imaging                posttest
                                        N Engl J Med. 2010 Jul 1;363(1):4-6
PROFESSIONALISM IN RADIOLOGY / SKILLS                    APDR Resident Professionalism Module        20



case
        Discussion
 1                                                                                         module start
        Essential information to obtain in a
        radiology consult:                                                                        pretest


          1.    Referrer name and contact number (e.g., pager)
                                                                                         professionalism
          2.    Patient age, gender, current location                                        in medicine


          3.    Clinical history
                                                                                         professionalism
          4.    If female: LMP, bHCG/urine pregnancy test if                                 in radiology

                premenopausal if any question of pregnancy
                (especially CT, or interventional fluoroscopy                                       skills
                procedure)
          5.    Prior imaging tests: e.g., plain radiographs                                    behaviors

          6.    Contraindications: e.g., creatinine level, devices
          7.    Mobility or mental status problems                                                service


          8.    If procedure: lab values (PT, PTT, INR), medications
                (e.g., anticoagulants), allergies, consent ability                               posttest
PROFESSIONALISM IN RADIOLOGY / SKILLS                   APDR Resident Professionalism Module        21




case
                                                                                          module start
 2         During review of on-call CT scans, the radiology
       attending you are working with identifies a 5-cm AAA in                                   pretest
       a patient who came to emergency room last night for
       renal colic. The preliminary                                                     professionalism
                                                                                            in medicine
       report described the ureter
       stone, but not the AAA.
                                                                                        professionalism
       Which of the following is                                                            in radiology

       the appropriate next step?
                                                                                                   skills




           A.   Report the findings in the final written report                                behaviors



           B.   Speak with the physician taking care of the patient                              service


           C.   Email or text the physician with the result
                                                                                                posttest
PROFESSIONALISM IN RADIOLOGY / SKILLS                                           APDR Resident Professionalism Module        22




case
                                                                                                                  module start
 2      correct answer is “B”:
        Speak with the physician taking care of the patient.                                                             pretest




         Critical findings must be relayed to the responsible                                                   professionalism
                                                                                                                    in medicine

         physician either verbally or by electronic media like
         email or text messaging. (For electronic media a                                                       professionalism
                                                                                                                    in radiology
         confirmation of message receipt must be obtained.)
                                                                                                                           skills

         It is essential to document in the final report the name
                                                                                                                       behaviors
         of the physician and the time of communication of
         discrepant or critical results.
                                                                                                                         service




Raskin. The Perils of Communicating the Unexpected Finding J Am Coll Radiol 2010;7:791-795                              posttest

Failure of radiologic communication: An increasing cause of malpractice litigation and harm to patients
Applied Radiology; Vol 39, Number 1-2. January 2010
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                      APDR Resident Professionalism Module        23




 3.   Professional Responsibilities                                                             module start



                                                                                                       pretest


       maintain collaborative and
                                                                                              professionalism
       respectful relationships,                                                                  in medicine
       treating everyone as you
       would want to be treated                                                               professionalism
                                           be prepared to report colleagues                       in radiology
         •   colleagues                    for unprofessional behavior
         •   support staff
                                             •   substance abuse                                         skills

         •   referring staff
                                             •   inadequate care
                                                                                                     behaviors
                                             •   unethical behavior
                                             •   boundary violations                                   service
                                                 (patients or staff)
                                                                                                      posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                APDR Resident Professionalism Module        24




case
                                                                                          module start
 3       For a radiology conference abstract, your attending
     asks you to obtain clinical history for the cases. This                                     pretest
     information isn’t readily available, and with the deadline
     next week, the fellow who is also on the abstract offers to                        professionalism
                                                                                            in medicine
     make up the histories. What would you do?
                                                                                        professionalism
                                                                                            in radiology


          A.   Go along with the idea – who would know?
                                                                                                   skills
          B.   Tell the fellow that you do not like the idea and
               will report him or her to the attending if he does                              behaviors


          C.   Delete the cases that don’t have the information
                                                                                                 service
          D.   Explain to the attending the problems and ask
               how you should proceed                                                           posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                      APDR Resident Professionalism Module        25




case
                                                                                                module start
 3        correct answer is “D”:
          Explain to the attending the problems                                                        pretest

          and ask how you should proceed.
                                                                                              professionalism
                                                                                                  in medicine
       •You need accurate reporting and analysis of research data,
       even for educational exhibits.                                                         professionalism
                                                                                                  in radiology
       •If information is vital to the exhibit and cannot be obtained in
       time, it should not be submitted.
                                                                                                         skills
       •There are professional and legal repercussions to inaccurate
       data gathering - especially if intentional.                                                   behaviors




                 
                                                                                                       service
                      All authors are responsible for contents.
                                                                                                      posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                              APDR Resident Professionalism Module        26




                                                                                                        module start
 4.   Honesty with Patients
                                                                                                               pretest



      •   state your level of training/experience                                                     professionalism
                                                                                                          in medicine

      •   know how to discuss of imaging results with patients
                                                                                                      professionalism
      •   know how to obtain informed consent for procedures                                              in radiology



                                                                                                                 skills



                                                                                                             behaviors



                            American College of Radiology (ACR) practice guideline for                         service
                            communication of diagnostic imaging findings.

                            Smith and Gunderman. Should We Inform Patients of                                 posttest

                            Radiology Results? Radiology 2010 255:317-21
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                APDR Resident Professionalism Module        27




case
                                                                                          module start
 4        While you are doing an RUQ US, you see what you
       think is a mass in the liver. The patient asks, ―What do                                  pretest

       you see?”What would you say?
                                                                                        professionalism
                                                                                            in medicine



                                                                                        professionalism
                                                                                            in radiology


          A.   ―Nothing, really. I’m sure everything is fine.”                                     skills

          B.   ―I’m a resident – the radiologist will look and
               make a final interpretation.”                                                   behaviors


          C.   ―You have a liver lesion that must be further                                     service
               evaluated.”
          D.   ―I’m sorry – but I think you have cancer.”                                       posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS               APDR Resident Professionalism Module        28




case
                                                                                         module start
 4       correct answer is “B”
       “I’m a resident. The radiologist will look                                               pretest

       and make a final interpretation.”
                                                                                       professionalism
                                                                                           in medicine

         Balance being honest, supportive, yet not
         overstepping your boundaries as a resident.                                   professionalism
                                                                                           in radiology




         Ask your attending to show you how to discuss                                            skills

         results with patients, observe you do it and give
         you feedback.                                                                        behaviors



                                                                                                service



                                                                                               posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                 APDR Resident Professionalism Module        29




                                                                                           module start
 5.   Patient Confidentiality
                                                                                                  pretest



        • keep patient’s issues private                                                  professionalism
                                                                                             in medicine

        • remove patient information from images before
          using for conferences, exhibits, publications                                  professionalism
                                                                                             in radiology



                                                                                                    skills



                                                                                                behaviors



                  If “cropping” information on                                                   service
                   downloaded images, confirm that it
                   cannot be reversed to original size                                           posttest
                   containing information
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                 APDR Resident Professionalism Module        30




case
                                                                                           module start
 5       During an US exam on a 16 y/o girl for RLQ pain, the
       patient states, “Please don’t tell my mother, but I might                                  pretest

       be pregnant.” What would you do?
                                                                                         professionalism
                                                                                             in medicine



                                                                                         professionalism
                                                                                             in radiology

          A.   Do nothing.
                                                                                                    skills
          B.   Tell the mother.
          C.   Tell the patient to tell the mother or that                                      behaviors

               otherwise you will.
                                                                                                  service
          D.   Tell the attending radiologist so he or she can
               inform the primary care physician.
                                                                                                 posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS             APDR Resident Professionalism Module        31




case
                                                                                       module start
 5     correct answer is “D”:
       Tell the attending radiologist so he or she can                                        pretest

       inform the referring physician.
                                                                                     professionalism
                                                                                         in medicine



       This may relate to the patient’s symptoms and                                 professionalism
                                                                                         in radiology
       will need to be pursued by her physician with a
       pregnancy test, who can discuss the results with
                                                                                                skills
       the patient.
                                                                                            behaviors



                                                                                              service



                                                                                             posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS              APDR Resident Professionalism Module        32




                                                                                        module start

case
 6       You are in an elevator and hear an interesting                                        pretest

       discussion of a patient’s case. The name of the
       patient is not mentioned.                                                      professionalism
                                                                                          in medicine



       Does this violate patient confidentiality?                                     professionalism
                                                                                          in radiology



                                                                                                 skills



                                                                                             behaviors



                                                                                               service



                                                                                              posttest
 PROFESSIONALISM IN RADIOLOGY / BEHAVIORS               APDR Resident Professionalism Module        33




                                                                                          module start

case
  6         correct answer is “YES”                                                              pretest



                                                                                        professionalism
                                                                                            in medicine
           • The case might have other identifiers such as
             diagnosis, patient location
                                                                                        professionalism
                                                                                            in radiology

           • NO patient information should be discussed in
             a public forum                                                                        skills




           • You can suggest to the discussants to continue                                    behaviors

             the conversation in another location
                                                                                                 service



                                                                                                posttest

Privacy of patients' information in hospital lifts:
observational study BMJ 2003:327;1024
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                  APDR Resident Professionalism Module        34




case                                                                                        module start

 7       A celebrity that you admire is admitted to the hospital.
                                                                                                   pretest
       You want to look at their images on the PACS system.
       When is this allowed?
                                                                                          professionalism
                                                                                              in medicine




         A.   If you will be taking care of the patient                                   professionalism
                                                                                              in radiology


         B.   If you are only looking and won’t be saving the data
                                                                                                     skills

         C.   If you are only looking and won’t be showing the
              images to your friends or others                                                   behaviors


         D.   Never                                                                                service



                                                                                                  posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                  APDR Resident Professionalism Module        35




case                                                                                        module start

 7      correct answer is “A”:
                                                                                                   pretest
        Only if you will be taking care of the patient.
                                                                                          professionalism
                                                                                              in medicine



       • The same applies to ANY patient including                                        professionalism
                                                                                              in radiology
         colleagues, friends, family
                                                                                                     skills


       • There are legal consequences to unauthorized
                                                                                                 behaviors
         access, which can be tracked
                                                                                                   service



                                                                                                  posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                       APDR Resident Professionalism Module        36




                                                                                                 module start
 6.   Appropriate Patient Relationships
         •   boundaries                                                                                 pretest

         •   appearance
         •   language                                                                          professionalism
                                                                                                   in medicine
         •   gifts
                                                                                               professionalism
                                                                                                   in radiology


             Given the inherent vulnerability and dependency
                                                                                                          skills
             of patients, certain relationships between
             physicians and patients must be avoided. In
                                                                                                      behaviors
             particular, physicians should never exploit
             patients for any sexual advantage, personal
                                                                                                        service
             financial gain, or other private purpose.
                                                                                                       posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS            APDR Resident Professionalism Module        37




case
                                                                                      module start
 8       While you are on an obstetric ultrasound rotation, a
       patient undergoing an ultrasound for a high risk                                      pretest
       pregnancy asks you to be friends on Facebook so you can
       see pictures of her baby after delivery.                                     professionalism
                                                                                        in medicine

       Does this violate patient confidentiality?
                                                                                    professionalism
                                                                                        in radiology



                                                                                               skills


                            facebook
                                                                                           behaviors



                                                                                             service



                                                                                            posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                                 APDR Resident Professionalism Module        38




case
                                                                                                           module start
 8      Discussion
                                                                                                                  pretest
       • Do not accept invitations to social networking sites
         because of privacy concerns
                                                                                                         professionalism
                                                                                                             in medicine

       • Potential harm to therapeutic relationship/denial of
         insurance                                                                                       professionalism
                                                                                                             in radiology

       • Limit personal information on your own site
                                                                                                                    skills


                 consider what you would want your patients to know
                  about you                                                                                     behaviors


                 use appropriate photographs only
                                                                                                                  service

                 do not discuss your patients, colleagues or attendings
                                                                                                                 posttest

                               Medical professionalism in the age of online social
                               networking. J Med Ethics 2009;35:584–586
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS              APDR Resident Professionalism Module        39




case                                                                                    module start

 9        You become attracted to a patient who has returned
       several times for spontaneous pneumothoraces. The                                       pretest

       patient senses this and asks you to go out for dinner.
                                                                                      professionalism
       You explain that you cannot because of respect for the                             in medicine

       patient-physician relationship.
                                                                                      professionalism
       One year later, however, you meet this former patient                              in radiology

       at the gym and agree to go out for coffee.
                                                                                                 skills



         Would this be considered                                                            behaviors

         professional behavior by your
         state licensing body?                                                                 service



                                                                                              posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                      APDR Resident Professionalism Module        40




case                                                                                            module start

 9      Discussion
                                                                                                       pretest


        Legally there is ambiguity, as state laws differ.                                     professionalism
                                                                                                  in medicine
        Ethically the clearest guideline is given by the
        American Medical Association, which advises that                                      professionalism
                                                                                                  in radiology
        such relationships are never appropriate.
                                                                                                         skills

            in general . . .
                                                                                                     behaviors

                   no outside relationship within one year
                    of treatment

                   psychotherapy: lifetime ban
                                                                                                       service



                                                                                                      posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS              APDR Resident Professionalism Module        41




case                                                                                    module start

 9      Discussion
                                                                                               pretest


        Why is initiation of a friendship or romantic
                                                                                      professionalism
        relationship with your patient not acceptable?                                    in medicine



         • physician has a fiduciary relationship to the patient                      professionalism
                                                                                          in radiology

         • physician is responsible for managing boundaries
                                                                                                 skills



                                                                                             behaviors



                                                                                               service
                Fiduciary: held or founded in trust
                or confidence
                                                                                              posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS               APDR Resident Professionalism Module        42


appropriate patient relationships
                                                                                         module start


 How can you manage boundary transgression                                                      pretest
 with a patient if it happens?
                                                                                       professionalism
      1. recognize transgression has occurred                                              in medicine



      2. manage transgression                                                          professionalism
                                                                                           in radiology
         – Divert patient approaches discretely & tactfully
         – Communicate & document (e.g., letter) with supervisor                                  skills



      3. prevent future transgression                                                         behaviors

         – Recognize early signs of transgression in your own &
           patient’s behavior                                                                   service

         – Examine boundaries and methods of preventing
                                                                                               posttest
           transgression
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                     APDR Resident Professionalism Module        43


appropriate patient relationships
                                                                                               module start


     How can you ensure your appearance is
     appropriate?                                                     ?                               pretest



                                                                                             professionalism
                                                                                                 in medicine

          • consider your intent when you choosing your outfit
                                                                                             professionalism
                                                                                                 in radiology
          • attire should not embarrass or distance patient
             – ensure your attire is clean                                                              skills

             – avoid under-dressing (torn, tight, short, revealing)
             – avoid over-dressing (e.g.,very expensive clothes)                                    behaviors


          • avoid fragrances                                                                          service
             – may trigger asthma, allergy, migraine headache
                                                                                                     posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                   APDR Resident Professionalism Module        44


appropriate patient relationships
                                                                                             module start


     How can you ensure your language with                                                          pretest
     the patient is appropriate?
                                                                                           professionalism
                                                                                               in medicine
          • Address the patients formally (Mr., Mrs., Ms.) unless
            they offer informal address                                                    professionalism
                                                                                               in radiology
          • Avoid overly-familiar address, e.g., ―dear,‖ ―honey”
          • Avoid jargon and condescending language: offer                                            skills

            explanations at the patient’s level but not below it
          • Be sensitive to the patient’s state of mind, e.g., how                                behaviors

            anxiety can affect the patient’s responses
                                                                                                    service
          • Be careful about the impact of humor: not everyone will
            “get it‖ or respond as you intended
                                                                                                   posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS              APDR Resident Professionalism Module        45




case
                                                                                        module start
10     During an US-guided breast biopsy, a colleague asks you if
       you watched the game the previous night.                                                pretest


       How would you respond?
                                                                                      professionalism
                                                                                          in medicine



        A.   You discuss the game with the other resident,                            professionalism
             while ignoring the patient                                                   in radiology



        B.   You ignore the other resident and concentrate on                                    skills

             watching the patient procedure
                                                                                             behaviors
        C.   You respond to the other resident, but involve the
             patient in the discussion, ready to change the                                    service
             subject if the patient is not interested
                                                                                              posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                  APDR Resident Professionalism Module        46




case
                                                                                            module start
10     Correct answer is “C”
                                                                                                   pretest
       You can respond to the other resident, but involve the
       patient in the discussion, ready to change the subject if
                                                                                          professionalism
       the patient is not interested.                                                         in medicine



        Be sensitive to the patient’s comfort and peace of mind.                          professionalism
                                                                                              in radiology


           • at times, ―small talk‖ can help relax a patient—but
                                                                                                     skills
             involve them in the conversation.
           • at other times, it can be annoying—many patients                                    behaviors
             prefer silence.
                                                                                                   service



                                                                                                  posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                APDR Resident Professionalism Module        47




case                                                                                      module start

11        On a radiology rotation, as you are consenting a
                                                                                                 pretest
       75-year-old female patient for a biopsy, she jokes
       about how young you look. How would you respond?
                                                                                        professionalism
                                                                                            in medicine


         A.   Ignore the patient’s comment.                                             professionalism
                                                                                            in radiology
         B.   Tell the patient it’s thanks to Botox, and she
              should try it too.                                                                   skills

         C.   Offer supportive remarks and explore her
              concerns.                                                                        behaviors


         Consider potential consequences to each of the
                                                                                                 service
            above actions! (see next page)
                                                                                                posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                         APDR Resident Professionalism Module        48




case                                                                                               module start

11          best answer is “C”
                                                                                                          pretest

       A.    If you ignore the patient you convey a lack of interest or
             attention.                                                                          professionalism
                                                                                                     in medicine

       B.    The patient may misperceive a comment. For example,
             the patient might feel put down and there may be a                                  professionalism
                                                                                                     in radiology
             barrier to communication.
       C.    You should explore if the patient feels anxious and try                                        skills

             to minimize the patient’s concerns by offering
             empathetic comments to show you understand.                                                behaviors




       e.g., “Yes, I know, I get that a lot. But don’t worry, I am                                        service


             supervised by a radiology attending during the procedure.”
                                                                                                         posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                APDR Resident Professionalism Module        49




case                                                                                      module start

12        The parents of a pediatric patient offer you tickets
                                                                                                 pretest
       to a game in appreciation for arranging a CT scan.
       How should you respond?
                                                                                        professionalism
                                                                                            in medicine

         A.   You say you cannot accept gifts from patients.
                                                                                        professionalism
         B.   You say thank you warmly, accept the gift, and say                            in radiology

              there was absolutely no need for the gift.
                                                                                                   skills
         C.   You say thank you, that the team is your favorite and
              it is a pleasure to be given these tickets as a gift.                            behaviors



                                                                                                 service



                                                                                                posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                      APDR Resident Professionalism Module        50




case                                                                                            module start

12      Discussion
                                                                                                       pretest

        Institutional policies vary from ―no gift‖ to a specific
        limit on the value of the gift. There is no simple                                    professionalism
                                                                                                  in medicine
        ―yes”or“no”answer.
                       • It may be acceptable for physicians to accept                        professionalism
                                                                                                  in radiology
                         modest gifts from patients.
                       • Gifts may interfere with decision making.                                       skills

                       • The family may perceive that the gift was
                         expected.                                                                   behaviors




                               consider the impact on their future                                     service

                              interactions with medical professionals.
                                                                                                      posttest
PROFESSIONALISM IN RADIOLOGY / SERVICE             APDR Resident Professionalism Module        51




                                                                                     module start
   7. Improving Access to Care
                                                                                            pretest

        Medical professionalism demands the
        commitment to reducing barriers to equitable                               professionalism
                                                                                       in medicine
        health care.
          • financial barriers                                                     professionalism
                                                                                       in radiology

          • educational barriers
                                                                                              skills
          • social discrimination

                                                                                          behaviors



                                                                                            service



                                                                                           posttest
PROFESSIONALISM IN RADIOLOGY / SERVICE                        APDR Resident Professionalism Module        52




                                                                                                module start
   8.    Just Distribution of Finite Resources
                                                                                                       pretest

   •    consider cost-effective management of limited
        clinical resources                                                                    professionalism
                                                                                                  in medicine
   •    consider implications of exposing patients to
        superfluous studies                                                                   professionalism
                                                                                                  in radiology
              - radiation exposure and other
                  complications
                                                                                                         skills
              - diminished resources for others
                                                                                                     behaviors


   •    use ACR Appropriateness Criteria to
        recommend imaging tests                                                                        service



                                                                                                      posttest


 ACR Appropriateness Criteria® Available at: www.acr.org/ac
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                 APDR Resident Professionalism Module        53




case
                                                                                           module start
13      You are on a radiology rotation and get a call from the
     medicine intern. One of his patients, who lives 2 hours                                      pretest

     away, is about to be discharged. The patient is scheduled
     for an outpatient CT chest in 2 weeks, but the intern                               professionalism
                                                                                             in medicine
     requests the CT today instead. Which response would be
     appropriate?                                                                        professionalism
                                                                                             in radiology



                                                                                                    skills
        A.   Ask why the CT scan was ordered
        B.   Check with CT for openings today                                                   behaviors


        C.   Tell the intern that the patient will need to get the
                                                                                                  service
             CT as an outpatient
                                                                                                 posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                  APDR Resident Professionalism Module        54




                                                                                            module start

case
13      correct answer is “A”                                                                      pretest



         Ask why the CT scan was ordered.                                                 professionalism
                                                                                              in medicine

        The request from a colleague should not be the basis for
        special consideration. In this illustration, the scan was                         professionalism
                                                                                              in radiology
        ordered for follow-up of a chronic condition, and not for a
        deterioration of condition. This standard outpatient study
                                                                                                     skills
        shouldn’t be prioritized at the potential expense of limiting
        access by sicker patients.
                                                                                                 behaviors



                in prioritizing study requests                                                     service


                • collect information
                      • speak to the radiology attending for advice
                                                                                                 posttest
PROFESSIONALISM IN RADIOLOGY / SERVICE                          APDR Resident Professionalism Module        55




                                                                                                  module start



     9.   Managing Conflicts of Interest                                                                 pretest



           •   essential in maintaining trust with                                              professionalism
                                                                                                    in medicine
               colleagues and patients
           •   disclose conflicts of interest and be familiar                                   professionalism
                                                                                                    in radiology
               with how to appropriately manage those
               which arise
                                                                                                           skills

           •   avoid interaction with industries for private
               gain or personal advantage                                                              behaviors



                                                                                                         service



                                                                                                        posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS                            APDR Resident Professionalism Module        56




                                                                                                      module start
   When is it appropriate to accept gifts from Pharma?
    Never.                                                                                                   pretest



                                                                                                    professionalism
                                                                                                        in medicine
        PharmFree Policy and Pledge.
       “I am committed to the practice of medicine in the best interests of
                                                                                                    professionalism
        patients and to the pursuit of an education that is based on the best                           in radiology
        available evidence, rather than on advertising or promotion.
                                                                                                               skills
        “I, therefore, pledge to accept no money, gifts, or hospitality from
        the pharmaceutical industry; to seek unbiased sources of
        information and not rely on information disseminated by drug                                       behaviors

        companies; and to avoid conflicts of interest in my medical
        education and practice.”                                                                             service

                                        American Medical Student Association
                                                                                                            posttest
PROFESSIONALISM IN RADIOLOGY / BEHAVIORS              APDR Resident Professionalism Module        57




                                                                                        module start




       Posttest                                                                                pretest



                                                                                      professionalism
           In the next section are the questions you                                      in medicine

           considered at the start. Try again to answer
           them in light of the discussion and cases                                  professionalism
                                                                                          in radiology

           you have just read about.
                                                                                                 skills
           Click on the answer letter to see if you are
           correct.                                                                          behaviors



                                                                                               service



                                                                                              posttest
POSTTEST                                                  APDR Resident Professionalism Module        58




                                                                                            module start

    1. Your 10-year-old daughter is a patient at your medical
    center. Are you allowed to access the electronic medical                                       pretest

    record to check her x-ray results?
                                                                                          professionalism
                                                                                              in medicine

           A.   Yes, because she is your daughter
                                                                                          professionalism
           B.   Yes, because she is under 16                                                  in radiology


           C.   No, because you are not her physician
                                                                                                     skills

           D.   No, because she has not given written consent
                                                                                                 behaviors



            “C” is correct. You are not Sorry, that’s not correct.                                 service
            her physician so you cannot
            access her record.                                                                    posttest
POSTTEST                                                        APDR Resident Professionalism Module        59




                                                                                                  module start

    2. A sales representative from a leading CT manufacturer
    gives you a laser pointer labeled with the company name.                                             pretest

    Can you accept this gift?
                                                                                                professionalism
                                                                                                    in medicine
           A.   Yes, because its value is <$50
           B.   Yes, because you are not buying their equipment                                 professionalism
                                                                                                    in radiology

           C.   No, as it is labeled with the company name
                                                                                                           skills
           D.   No, as gifts should not be accepted from commercial
                companies                                                                              behaviors


            “D” is correct.                      Sorry, that’s not correct.                              service

            Gifts should not be accepted
            from commercial companies.                                                                  posttest
POSTTEST                                                       APDR Resident Professionalism Module        60




                                                                                                 module start

    3. An attractive patient flirts openly with you during an
    upper GI study. How should you react?                                                               pretest



           A.   Refuse to have any further contact with the patient                            professionalism
                                                                                                   in medicine

           B.   Tell the patient you are not interested and to stop flirting
                                                                                               professionalism
           C.   Include a chaperone at future meetings and if it                                   in radiology

                continues inform your attending
                                                                                                          skills
           D.   Make a date to see him/her after you are off the service
                                                                                                      behaviors


            “C” is correct.                     Sorry, that’s not correct.                              service

            Include a chaperone at future
            meetings and if it continues,                                                              posttest

            inform your attending
POSTTEST                                                      APDR Resident Professionalism Module        61




                                                                                                module start

    4. You are on call with a radiology fellow and you smell
    alcohol on his breath. How should you manage this                                                  pretest

    situation?
                                                                                              professionalism
                                                                                                  in medicine
           A.   Ignore it as he does not appear drunk
           B.   Confront him with your suspicions                                             professionalism
                                                                                                  in radiology


           C.   Call the attending on-call that night
                                                                                                         skills
           D.   Talk to the residency director the next day
                                                                                                     behaviors


            “C” is correct.                    Sorry, that’s not correct.                              service

            Call the attending—your
            primary responsibility is to                                                              posttest

            the patient.
POSTTEST                                                       APDR Resident Professionalism Module        62




                                                                                                 module start

    5. Can you use patient images for a presentation at a
    national meeting?                                                                                   pretest




           A.   under no circumstances                                                         professionalism
                                                                                                   in medicine


           B.   only if you sign a waiver
                                                                                               professionalism
                                                                                                   in radiology
           C.   if the patient signs a waiver
           D.   if the information is de-identified                                                       skills



                                                                                                      behaviors
            “D” is correct.
            Patient info must be de-identified;   Sorry, that’s not correct.                            service
            at the least, you must permanently
            delete: name, birthdate, date of
                                                                                                       posttest
            exam, hospital name
                                                   module start



                                                         pretest
                        The Resident as a
                    Professional in Radiology:   professionalism
                                                     in medicine
                       Self-learning Module

                                                 professionalism

                Congratulations on successful
                                                     in radiology


                completion of the module!                   skills



                                                       behaviors

Andrea Donovan, MD
Sravanthi Reddy, MD                                      service
Christopher Straus, MD
Petra Lewis, MD
                                                        posttest
AMSER Electronics Communication Committee

				
DOCUMENT INFO