Australian rural radiographers: radiographic interpretation, communication and disclosure of their radiographic opinion

Rural radiographers draw upon informally, experientially acquired knowledge in order to navigate dilemmas and activities that demonstrate complex ethical and social dimensions in their practice. Through an exploration of the social and historical world of the rural radiographer, this thesis generates a substantive theoretical insight into rural radiographers' participation in radiographic interpretation, communication with referrers and disclosure of their radiographic opinion to patients, with a specific focus on plain film radiography. A two phase, exploratory interpretive study was undertaken. The first phase employed a paper based questionnaire and elicited information from Australian rural radiographers that included demographic profile, context and patterns of service delivery. The purpose of the questionnaire was not to draw statistical conclusions about the rural radiographic population, but rather to gather a demographic snapshot of rural radiographers and to determine radiographers' involvement in radiographic interpretation, communication and disclosure of their radiographic opinion. To this end the quantitative component of the questionnaire data was analysed using frequency analysis. Consistent with field literature, the questionnaire data demonstrated that radiographers are engaged in radiographic interpretation, communication with referrers and disclosure of their radiographic opinion to their patients. Emerging findings from the questionnaire provided the foundation for the second stage of the study, interviews with radiographers again providing radiographic services in rural Australia. The thematic analysis of the interview data revealed that, without a clear picture of where they stand medico-legally, rural radiographers draw on an experiential collective of radiographic perception and radiographic interpretation skills as the basis for the complex decisions they make about communication and disclosure of their radiographic opinion. Furthermore, the findings show that the level and method of disclosure chosen by radiographers is governed by the diagnostic, therapeutic and emotional impact this disclosure may have on the patient. Rural radiography transcends the technical image that dominates the field literature and extends to a more humanistic endeavour: patient welfare is central to the practice world of the rural radiographer. Utilising a social constructionist framework, theoretical explanations of radiographic practices in relation to radiographic interpretation, communication and disclosure were generated. This study shows that rural radiographers' construct of their role in patient care extends beyond image acquisition into radiographic image reading, communication and disclosure of their radiographic opinion. A key finding from this study is that rural radiographers, guided by an ethic of care, navigate a complex interplay of variables as they decide the way in which to convey their radiographic opinion. Radiographers' communication of their radiographic opinion with referrers is mediated by the radiographer/referrer game and tends to diagnostic accuracy, but with patients, disclosure is diagnostically vague and may be understood as filtered truth. The way in which rural radiographers convey their radiographic opinion is contextual and informed by experiential knowledge that has evolved through their shared experience of clinical practice in rural settings. This knowledge contributes as equally to an effective outcome for the patient to a radiographic examination as the radiographer's technical expertise in image acquisition; it is however not well described in the radiographic literature nor does it seem to be commonly discussed amongst radiographers and their health care colleagues. The findings from this study indicate that a mismatch in educational preparation, compounded by a lack of professional guidelines and legislative clarity, has led to the ways in which radiographers choose to convey their radiographic opinion. It is important that this implicit and tacit dimension to rural radiographic practice is understood so that it can inform professional, educational and policy decisions relating to radiographers' contemporary scope of practice.