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Join us for a conversation with Houda Bouhmam, a radiology resident, as we explore the crucial collaboration between radiologists and clinicians in achieving the best diagnostic outcomes. Houda shares her transformative journey, dispelling misconceptions about clinical correlation and highlighting its importance in connecting radiographic findings with a patient’s clinical information. Discover practical strategies for effective collaboration and gain insights into the evolving role of clinical correlation in diagnostic radiology.

Houda Bouhmam is a radiology resident.

She discusses her KevinMD article, “The collaboration between radiologists and clinicians for optimal diagnostic outcomes.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Houda Bouhmam. She is a radiology resident. Today’s KevinMD article is titled “The collaboration between radiologists and clinicians for optimal diagnostic outcomes.” Houda, welcome back to the show.

Houda Bouhmam: Hi, nice to see you again, Kevin.

Kevin Pho: So we’ll get into the article in a little bit, but for those who didn’t listen to our first episode together, just briefly share your story and journey to where you are today.

Houda Bouhmam: Sure. Yeah, my name is Houda, like you said. I did my medical school at Penn State College of Medicine in Pennsylvania, then I did one year of internship in Northeast Philadelphia, and here I am doing my radiology residency in New Jersey, at Robert Wood Johnson with Rutgers University.

Kevin Pho: All right, so we talked offline, and you’re going into your PGY-4 year. How’s radiology residency?

Houda Bouhmam: Great. It’s great. I mean, the workload definitely is increasing, but I’m loving it. I’m doing a lot more overnight shifts this year and the upcoming year, but it’s all part of the learning process.

Kevin Pho: All right, well, tell me some of the rewards and challenges of radiology today.

Houda Bouhmam: Definitely the increasing workload. There’s a lot of imaging coming in, and we need a lot more, and a lot more every day, and that’s more the older attendings saying the same thing; that’s just me recently joining radiology. So we are bombarded by the load, and we also have to keep the accuracy of the reports and the diagnoses, and keep our connections with the clinical profile and everything else. So I think that’s a big challenge.

Kevin Pho: So for those medical students who are listening to you, you’re in the midst of your radiology residency. Tell me, what kind of questions do they ask themselves if they want to consider radiology as a career today?

Houda Bouhmam: Actually, that’s part of it. I wrote this article, and I’m here today, because of the medical students. As a medical student, I didn’t get the presentation I wanted about radiology, because the traditional way radiology is presented to medical students is viewing images as a complement to pathology, anatomy, and physiology. But it really is more than that. I highly encourage them to come down to their reading room and shadow with us and talk to us, and have an actual, real-time rotation with us, to see that we do a lot more than just interpreting images. The interpretation of images itself includes a lot more than just viewing the image and writing a report of what it could be, or giving a differential diagnosis.

There’s a lot we consider. We may need to talk to the clinician. We may need to go into the chart and read about the history, read about the personal and family history, and gather a little bit more information about the lab values of that day, to give the most appropriate diagnosis, or, if not, what’s highest on the list of the differential diagnosis. So there’s a little bit more involvement than what is traditionally presented to medical students about radiology. There’s a little bit more involvement.

And I know it is very challenging, with what I just told you about the increase in the load; having a medical student with you is challenging, but it’s definitely doable. I highly encourage them to be active in the rotation and ask questions. We’re all friendly, and we love to have future radiologists with us who are dedicated and engaged, so we love to engage them as best as we can.

Kevin Pho: All right, so let’s talk more about that KevinMD article. It’s titled “The collaboration between radiologists and clinicians for optimal diagnostic outcomes.” Let’s see if we can clear up some of these misperceptions here. So tell us, how did your article come together?

Houda Bouhmam: Like I said, the traditional definition of diagnostic radiology is interpretation of images and giving a list of differential diagnoses. I thought it needed to come to an end, and someone needed to say, whether I write about it or speak about it, that we do a lot more than that. Our work, our daily routine, involves a lot more than just giving the clinicians a report. It’s a close kinship with the clinicians. We can’t do our work without them, and they can’t do their work without us.

In a big hospital, a tertiary hospital, we are constantly on the phone with the clinicians, and they’re constantly in our reading room discussing cases, talking about potential diagnoses and what it could be, because not every case is bread and butter, like acute appendicitis or something that’s very easy. Some cases are very challenging, and we need each other. We need to talk to each other to get the optimal, or the best, diagnosis possible.

So that’s why I wanted to write this article, to define radiology a little bit closer to what it actually is. We are involved in patient safety. We are involved in protocoling studies. Many clinicians call us before ordering a certain study. They give us the clinical scenario, and they ask us, “Well, what’s the appropriate study? Do we need contrast? Do we need oral contrast? Do we need intravenous contrast?” We are involved in all of this. We are not only reading images. That’s why I wanted to write an article or speak about it, and tell medical students who are interested in radiology that it’s more than what is traditionally advertised, and tell the clinicians who are not necessarily in close kinship with the radiologists that we do more than that.

Kevin Pho: So tell us a story, case study, or example where that collaboration with clinicians led to a positive patient outcome or made a difference in the patient’s diagnostic course.

Houda Bouhmam: I mean, all the time. I can share one with you. I was reading out a brain MRI with my neuroradiology attending, and we read it as normal, a normal brain MRI. The neuro team came down right at the time when we were reading out that case, and there was a very subtle finding that we missed initially. But when they came to us and presented the patient, we went back and looked, and it was a very, very subtle acute finding that, based on that presentation, we could figure out. When we went back and looked, it was very, very small, something that you can very easily miss. But because they came and presented the clinical picture, the symptoms of the patient, we went back and read it, and it was true: There was an acute, very, very small acute infarction.

So that’s a very, very small example that came to my mind as you asked, and we have plenty of examples like that every day. That’s why it’s very, very important to give us the clinical picture, and very important for the radiologists, too, if they are not sure why the study is being done, to make that extra call or go to the chart and look for extra information.

Kevin Pho: So when it comes to the clinical information that radiologists need to do their jobs to the best of their ability, exactly what type of information would be most helpful for us to give to you?

Houda Bouhmam: It depends on the study. For example, if it’s an abdomen and pelvis, and the clinical indication says abdominal pain, but you see a lot more than that, for example, you see lymphadenopathy everywhere, then there’s probably more than abdominal pain. Maybe there’s cancer involved, or maybe there is some infection that’s more involved. So when there’s merely abdominal pain and you see a lot more radiographic findings, it’s got to be something more than that. So you either call the clinician or look for more information in the chart, if it’s available.

I understand that not all practices have a chart available for every patient. It depends, again, on the practice. I’m very fortunate to be in a big hospital where I have access to the patient chart and I have access to their clinicians. I can call anytime, and they can come down to the reading room. So I’m lucky in that sense, and I have no problem with that.

Kevin Pho: So tell us how the field of radiology has been changing. Give us an example of how AI intersects with radiology. Are you using it to help transcribe? What are some examples of AI tools that you would use to increase efficiency in radiology?

Houda Bouhmam: An example of that would be the one that I see used the most, which is with strokes. When a stroke patient comes in, there is something called RAPID that picks up a possible, we call it a possible occlusion, a vascular occlusion, or a stenosis in that area. It highlights it in a color, so it tells you, “Oh, maybe there’s something there.” Sometimes it’s right and sometimes it’s wrong. That’s why you definitely need a radiologist to go back and go through all the vessels and make sure there is or isn’t an occlusion. But that’s the one thing: It rapidly tells you, “Oh, maybe you’ll need to look at that area specifically. There might be something there, occluded, or a stenosis at least.”

Kevin Pho: We’re talking to Houda Bouhmam. She is a radiology resident. Her KevinMD article is titled “The collaboration between radiologists and clinicians for optimal diagnostic outcomes.” So let’s get back to that relationship between radiologists and clinicians. What are some red flags? What are some things that we as clinicians should not do when it comes to interacting with radiologists?

Houda Bouhmam: You should not ignore your importance, your hand in our hand, because there is a patient, and both you and I have a goal of giving the optimal care to that patient.

I am going to share a very small story that I had when I was training in Senegal as a fourth-year medical student. I did a global rotation, and I didn’t know much about radiology at the time, but I did witness a very tense conversation between a radiologist and a gastroenterologist, where the radiologist refused to read a scan because, she said, she didn’t have adequate clinical information. At the time, I didn’t understand that. I just questioned myself: Why did the radiologist have that reaction? She just said, “I don’t have adequate clinical information. I see radiographic findings here, but I can’t give you an impression.” Basically, that’s what she said, and she left. She didn’t read the scan. And then I left, and I didn’t understand anything about that conversation. But in my head, I was like, “Why did the radiologist react like that? She could have just reported the scan, and the day would be over.”

But then, going into radiology and understanding what it encompasses and the impact we have on patient care, I understood the importance of having the full patient profile and the importance of having the background to write your impression, because you want to be helpful. You don’t just want to have a template and fill in all your organs, what’s normal and what’s not. The patient is not a matter of entities; you have to look at it as one thing, and we have to get together to do that. That’s my main point: getting together, because no one can do medicine alone. That’s what we’ve been taught in medicine. It’s all team-based; we all do it together, and that’s what radiology is.

Kevin Pho: And my final question: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Houda Bouhmam: I want my medical students to please come rotate with us and try to get a feel for radiology. It’s more than what is given to you traditionally in medical school. We’re a lot more involved in patient care, sometimes directly in patient care. We talk to patients. We discuss their safety in terms of contrast, giving them contrast, and contrast reactions; we do deal with those. And also the health care systems and insurances: We’re aware of all that, and we discuss that, too, on a daily basis.

My second message is to the clinicians, again: to have that collaboration, to work with us, even in outpatient settings, to call us when you don’t understand the radiographic finding, and to call us when you feel like the report does not match the clinical picture. If you’re suspicious of something, even if you get the final report and still have a suspicion, call us back. And to my radiologists: Call the clinicians when you need information, when you feel like you have a gap that’s missing, and let’s get that kinship going for the best of our patients.

Kevin Pho: Houda, thank you so much for coming back on the show and sharing your time and insight.

Houda Bouhmam: Yes, of course. Thanks for having me, Kevin.