Raj Burgul

Dad, NHS radiologist, cyclist, kitesurfer.

[Raj Burgul @rburgul]

@valhumphreys51 @DrJoFranklin @chriscraigCCC Except if we’re sinking in referrals and I phone GP practice and get automated message and GP is consulting anyway. Can try email but who checks?
If only our IT referral systems supported some form of quick dialogue?
See the issue?

[Raj Burgul @rburgul]

@ConsUltaNT_ACP @cannula_service Exactly this.
20y female with abdominal pain - request Xray abdomen please.
—->reject.
We’re struggling in radiology with much lower thresholds for imaging.

[Raj Burgul @rburgul]

@Jean_Jeannie1 @medicalmodelbri I’m going to put my hand up and say I have rejected GP referrals and it’s not uncommon. It’s complex. Vast majority are good referrals but around 10% we may knock back. Same for in hosp referrals.
Actually truth be told, I rarely reject but ask for clarification.

[Raj Burgul @rburgul]

@DrAnimeshSingh @DrJPGannon Gosh. My response gets auto tagged as ‘probable spam’. Just love X sometimes!

[Raj Burgul @rburgul]

@DrAnimeshSingh @DrJPGannon Main issue we find is that whilst radiographers very good and get skilled at abnormality pick up, it’s the interpretation of the finding and furthermore the advice to clinician that has less value than a doctor.
In particular GP reports need clear guidance as to next steps.

[Raj Burgul @rburgul]

@Neuro_Matt What about full neuro prior to cross sectional imaging of the brain?

[Raj Burgul @rburgul]

@debzly @medicalmodelbri @GMCharlatan @RCRadiologists @SheffieldHosp @GSTTnhs @AmandaPritchard Requests from non doctors is not new (usually limited indications). Final decision is devolved to individual trusts/ boards. Agree that ionising radiation is not being taken seriously enough.

[Raj Burgul @rburgul]

@mancunianmedic You’ve gone too far this time… 😆

[Raj Burgul @rburgul]

@Neuro_Matt Not just spinal. Many (most?) requests for any area look for ‘issues’, ?pathology, ?cause. Few actually give a coherent differential or proposed management.
The point of radiology is not to make a diagnosis but to change the outcome. There’s a difference.

[Raj Burgul @rburgul]

@Rsk614056768972 @goldstone_tony @BMA_Pensions I think you should put in your correct pensionable pay. For 22-23 you will be automatically on the CARE scheme.
1995 benefit is based on best of last 3 years pay and will have negligible PIA for that year.
Either way you will not have an annual allowance charge.

[Raj Burgul @rburgul]

@goldstone_tony @BMA_Pensions Correct. We need both. The baseline data for each year as you describe above should be on PSS for all staff.
But given HMRC holds us responsible for correctly calculating AA / PIA surely the exact ‘official’ methodology should be available to all of us.

[Raj Burgul @rburgul]

@clare_angela_ You seem to have done a good job of choosing the best specialty!

[Raj Burgul @rburgul]

@Roddy_Neilson @DrDeepPsyche Likewise this Raj can’t quite remember which end of a stethothing goes where!

[Raj Burgul @rburgul]

@goldstone_tony Thanks Tony. Your spreadsheet was really useful and reassuring. But if you can issue this why can’t the NHSBSA or SPPA? Also, it may be me but nowhere have I seen a step by step guide on how to work out a PIA exactly (not estimate) for those in 1995/2015 schemes.

[Raj Burgul @rburgul]

@rob1066 @goldstone_tony Basically whole time work is pensionable and anything extra above this is not.
Discretionary points are pensionable and can cause the difference . EPAs and waiting list initiatives etc are not.
Salary sacrifice also causes differences.

[Raj Burgul @rburgul]

@schistosomnia @issypips Could’ve been worse and chosen radiology!

[Raj Burgul @rburgul]

@SueManby @danfurmedge Regardless of the story or findings, radiology provides comfort for the clinician by transfer of responsibility. Most doctors don’t do this but there are enough out there that do. Radiology is dead in the water.

[Raj Burgul @rburgul]

@MikeGriff11 @exitdave @joshuasforrest Im afraid he’s right Griff. For example more scanning provides more data in terms of multiple often tiny indeterminate abnormalities. This leads to patient anxiety and follow up tests. The vast majority are incidental and benign. There is no outcome improvement for the patient.

[Raj Burgul @rburgul]

@scottwww @jgarzik @joshuasforrest Exactly. The scan may show indeterminate features. This then triggers more serial scanning as you describe leading to patient anxiety and increased cost. Vast majority benign resulting in no outcome improvement - and a big bill.