RADIOLOGIST Q&A - Dr Maxine Murray, Consultant Radiologist
What is your role within MEDICA and tell us a little more about what you do?
I have several different roles at MEDICA. I have been a reporter for three years, mostly reporting neurology and chest scans, but I am also an auditor and arbitrator, providing feedback to other radiologists on their discrepancies. Until recently, I was also clinical lead for chest radiology, providing educational reviews to share interesting cases and learning points with other MEDICA radiologists and providing a second opinion on difficult/complex cases. I was also involved in assessing potential new areas for development in MEDICA including the use of artificial intelligence (AI) to measure and monitor lung nodules and to assess severity of disease in patients with emphysema. I am a trained appraiser and carry out regular appraisals on MEDICA radiologists for whom MEDICA is their designated body. I am also involved in writing annual reports for MEDICA radiologists to present at their NHS appraisals. I sit on the clinical governance committee which meets fortnightly to review all serious discrepancies, root cause analyses and any concerns about performance of radiologists or radiographers. I was appointed as clinical audit lead on 1st January 2018.
It’s true to say now that NHS radiologists balance a variety of responsibilities – working in the NHS, out-of-hours, in private practice, for teleradiology providers and teaching and research. You’ve also chosen to adopt the modern concept of a ‘portfolio career’ why was this attractive to you?
I enjoy the variety of my job. I can report from the convenience of my own home without constant interruptions which means I can really focus on what I am doing and provide timely and accurate reports. My reporting lists are tailored to my areas of expertise and by reporting for a number of specialist neurological centres, I feel I have been able to develop my expertise. There is no pressure to hurry the reports and I have the time to look up interesting cases as I go along which is great for learning. It can be quite isolating working as a teleradiologist, but MEDICA has a panel of clinical leads who are available to discuss interesting or difficult cases, which is a great support. I get to meet other radiologists in my role as appraiser and I work as part of a team with regular video-conferencing for the governance committee. My hours for MEDICA are flexible which means that I have been able to take up a post at Brighton and Sussex MEDICA School teaching the year two students which I thoroughly enjoy.
How important is it to strike work/life balance as a consultant radiologist and how has teleradiology helped you achieve that?
Having commuted to work for 15 years in the NHS, I now report from home which means that I don’t waste 2–3 hours per day travelling. The hours that I decide to work are flexible and I frequently have afternoons free, having reported in the morning. This flexibility has been particularly important to me owing to serious illness in a close family member.
With the majority of your doctors being remote how do you manage performance and quality and how do you quality assure your service?
The performance of all MEDICA radiologists is reviewed annually by a member of the clinical governance committee. This involves ensuring that continuing professional development (CPD) is up to date and relevant to the doctor’s scope of practice, a review of their job plan to ensure that the doctor is not working excessive hours, and a review of discrepancies with the learning points which have arisen through reflection. MEDICA also provide monthly educational reviews for radiologists which are based around interesting and informative cases which have been reviewed at the clinical governance committee. MEDICA radiologists are also asked to submit interesting cases to an educational folder for inclusion in these reviews.
“Urgent cases can be turned around in less than 24 minutes, which is clearly of benefit to patients.”
Does MEDICA’s approach to Clinical Governance and Quality Assurance differ from the NHS and how?
All MEDICA radiologists undertake an entry audit in which all of their initial reports are audited for discrepancies. Provided this is satisfactory they are then subjected to an ongoing background audit of a set percentage of their reporting. MEDICA radiologists receive a monthly report which details their level of discrepancy and compares this with the MEDICA average. All radiologists also receive an annual written report concerning their volume of reporting and discrepancy details for them to present at their NHS appraisal. In the NHS it is unusual to have regular audit of a radiologist’s work and most discrepancies are raised on an informal, ad hoc basis, often through discrepancy review meetings. Most NHS radiologists are not aware of their individual discrepancy rates.
Even the best doctors make some mistakes, how do you reduce this risk and manage errors when they do occur?
Mistakes are an inevitable part of clinical practice. By tailoring reporting lists to a particular radiologist’s experience, MEDICA is able to reduce the risk of radiologists reporting beyond their expertise. However, when mistakes are made, it is important to learn from them. Errors can be raised by individual Trusts or through the MEDICA audit process. MEDICA radiologists are asked to reflect in writing upon their errors and to identify specific areas where they could improve their practice. At the end of the year, MEDICA radiologists are asked to review all of their discrepancies, looking for patterns or trends which might be amenable to improvement. This might, for example, involve using a checklist to ensure that reports are comprehensive or may identify areas of the literature to review.
Tell us about the support network for doctors who work for MEDICA?
Working as a teleradiologist can be quite isolating but MEDICA provides a number of levels of support for radiologists. On a daily basis, there is access to technical support by telephone 24 hours a day. The support team are courteous and efficient and are able to escalate technical issues that they themselves are unable to deal with. There is also a system whereby radiologists can seek a second opinion from specialist radiologists for difficult or unusual cases. In terms of clinical governance, all radiologists are provided with a monthly summary of their discrepancy rates but there is also a bespoke appraisal system for those radiologists that work outside the NHS for whom MEDICA is their designated body. Appraisals are conducted annually by trained appraisers and are signed off by Dr Stephen Davies as Responsible Officer.
The demand for teleradiology is growing and we have touched upon how this set-up benefits the NHS and doctors, tell us how the teleradiology set-up impacts patient care?
Radiology is becoming increasingly sub-specialised and individual Trusts may have difficulty providing an expert opinion, particularly at short notice. Teleradiology companies have access to a broad cross-section of expertise amongst their reporting radiologists and are in an excellent position to provide timely, expert advice. Urgent cases can be turned around in less than 24 minutes, which is clearly of benefit to patients.