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Ethical impact of suboptimal referrals on delivery of care in radiology department
  1. Catherine Chilute Chilanga,
  2. Kristin Bakke Lysdahl
  1. Health and Social Sciences- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
  1. Correspondence to Catherine Chilute Chilanga, Health and Social Sciences- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg 3679, Norway; catherine.chilanga{at}usn.no

Abstract

The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles of non-maleficence, beneficence, Autonomy and Justice as an analytic framework.

Suboptimal referrals can cause harm by hindering safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patient benefits from the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patient autonomy is compromised from the lack of information needed to facilitate benefit–risk communication. Finally, suboptimal referrals challenge justice based on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.

These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct.

  • radiology
  • ethics
  • quality of health care
  • health personnel

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. The manuscript submitted was based on reviewed literature from scientific published journals all of which are available and accessible to the public.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. The manuscript submitted was based on reviewed literature from scientific published journals all of which are available and accessible to the public.

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Footnotes

  • Contributors Both authors, CCC and KBL read, reviewed and approved the final manuscript. The planning of this study was done by CCC and KBL contributed to the planning, structure and formatting. The conducting of the study was shared by both authors as follows: the methods, section on non-maleficence and beneficence challenges and discussion were written and reviewed by both CCC and KBL. Specific parts of individual contributed: CCC wrote most of the section on introduction section and autonomy challenges and KBL on justice challenges. CCC submitted the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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