Renegotiating expertise: an examination of PACS and the challenges to radiology using a medical anthropologic approach

Abstract

Purpose: The aim of this study was to examine how the adoption of PACS has affected the professional relationships among radiologists and referring providers and to evaluate the effect of PACS on perceptions of radiologists' roles in patient care.

Methods: A medical anthropologic approach was used to assess the impact of PACS among radiologists and a community of clinical subspecialists at a large academic medical center (n = 40). Data collection techniques included 3 months of ethnographic participant observation during the routine medical practice of study participants as well as semistructured interviews and archival research. These data were then analyzed to identify behavioral and narrative patterns and themes among the study populations.

Results: The difficulty of establishing and maintaining relationships of trust between referring providers and radiologists due to the drop in post-PACS reading room visits emerged as a major source of concern for study participants. By interacting primarily over the phone or at weekly conferences, radiologists felt that they had fewer opportunities to build personal relationships with other clinicians. Meanwhile, the specialist referring providers stated they generally consulted only radiologists with whom they had established personal relationships and otherwise preferred to interpret their patients' images themselves.

Conclusions: Generating and sustaining relationships of trust and effective communication are vital for radiologists to communicate their expertise in medical imaging to referring providers. Because PACS have caused a reduction in referring provider visits to the reading room, radiologists must seek out new opportunities to form personal relationships with other physicians.