title: The 'radiographer-referrer game': image interpretation dynamics in rural practice.
abstract: BACKGROUND
  Effective interprofessional communication is intrinsic to safe health care. Despite the identified positive impact of collaborative radiographic interpretation between rural radiographers and referrers, communication difficulties still exist. This article describes the strategies that Australian rural radiographers use for communication of their radiographic opinion to the referring doctor.
  
  
  METHODS
  In a two-phase interpretive doctoral study completed in 2012, data were collected from radiographers working in rural New South Wales, Western Australia and Tasmania using a paper based questionnaire followed by in-depth semistructured interviews. Data were analysed thematically in order to identify, analyse and report the emergent themes.
  
  
  RESULTS
  The overarching theme was Patient Advocacy, where in the interest of patient care radiographers took measures to ensure that a referring doctor did not miss radiographic abnormalities. Strong interprofessional relationships enabled direct communication pathways. Interprofessional boundaries shaped by historical hierarchical relationships, together with a lack of confidence and educational preparation for radiographic interpretation result in barriers to direct communication pathways. These barriers prompted radiographers to pursue indirect communication pathways, such as side-stepping and hint and hope.
  
  
  CONCLUSIONS
  A lack of formal communication pathways and educational preparation for this role has resulted in radiographers playing the radiographer-referrer game to overtly or covertly assist referrers in reaching a radiographic diagnosis. The findings from this study may be used to plan interventions for strengthening interprofessional communication pathways and improve quality of healthcare for patients.
authors.affiliation: Menzies Institute for Medical Research University of Tasmania Hobart Tasmania Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Squibb
authors.affiliation: Department of Rural Health University of Newcastle Taree New South Wales Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Smith
authors.affiliation: School of Health Sciences University of Tasmania Launceston Tasmania Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dalton
authors.affiliation: School of Health Sciences University of Tasmania Launceston Tasmania Australia.
authors.forename: Rosalind M
authors.initials: RM
authors.lastname: Bull
mesh_terms: D001315:Australia; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D033183:Interdisciplinary Communication; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*; D012424:Rural Population
keywords: Communication; interprofessional; radiography