“What? I have a ‘tumor’ in my head?!” – A Radiologist’s Dilemma in Delivering Reports to Patients

scared

 

It turned out that the tumor was entirely benign, asymptomatic, and clinically insignificant.

Ultimately good news.

However, because of the newly available patient portal to get access to the radiology reports immediately even before the referring physicians, patients are also experiencing many more unnecessary tosses and turns at nights because of the disturbing words in their reports. The reports are in plain English, and there are only few vocabularies which they can easily look up on Medscape or Google. Yet the meaning of these reports sometimes seems miles away from the conclusion drawn by their doctors.

As a radiologist myself, I have witnessed many aspects of life on my viewing box, the ups and downs, illnesses and recoveries. My job requires me to precisely describe what I see, provide a list of possible diagnoses, and suggest the next step in imaging management to the referring physicians and often end in the reports with “clinical correlation is suggested”.
While this last part is often snared upon and considered the hallmark of a radiologist lacking confidence, I have also witnessed many downfalls of excellent but over-confident colleagues/mentors because of incorrect assumptions and being unaware of clinical contexts.

The purpose of the last part of the report is to give the treating referring physicians room to generate alternative conclusions if there are circumstances that are unknown to the radiologists. Abnormal findings are not always dangerous. After all, we are all unique individuals. We have similar but unique bodies, and experience unique responses to diseases and treatments.

Direct and immediate access to radiology reports has raised many discussions in recent years (Ref 1-3). On one hand it is a national trend in keeping with the rapid evolution of electronic medical records (eHR) and the demand by the consumers; however, there are many unforeseen consequences with such direct immediate access. While the previous delay in reporting experienced by the patients often is a result of ineffective communication, the delay actually served as a buffer for information transmission between the medical community to the patients. That is, there is an additional filtering process through the treating physicians, the people who know the patients better than the radiologists. Several studies have advocated such delay or further investigation on the effects of immediate radiology reports to patients via the new technologies (Ref 1-3). Some suggest that patients prefer slightly longer delay in reporting if the report is highly abnormal. (Ref 1)

However, here is the reality. The reality is that many patients are now reading their radiology reports right after their exam without the filtering and explanation by their treating physicians. The patients are unaware of the knowledge gap or the complex process of synthesize a final diagnosis between the treating physician and their radiology consultants. So the bigger question is how the radiology community should react to this big change in information relay.

a. Should the imaging community offer standardized reporting technique to communicate to the patients that is different from the referring physician given the obvious knowledge gap. (e.g. ACR reporting guideline on mammograms)

b. Should the radiologists get ready to have Facetime with the patients whom they are not used to interact? Note that this still does not obviate the necessity of devising a new set of patient-friendly language specific for this kind of interactions.

c. Should the radiology community provide two different reports? One for the patients, and one for the treating physicians ?

Reference:

1. http://www.medscape.com/viewarticle/774768_1

Bypassing Doctors, Patients Take Charge of Radiology Images, Reports.

Greg Freiherr

2. http://www.jacr.org/article/S1546-1440%2809%2900525-0/abstract

Patient Access to Radiology Reports: What Do Physicians Think?

Johnson AJ, Frankel RM, et al.

3. http://www.jacr.org/article/S1546-1440%2811%2900780-0/abstract

Access to Radiologic Reports via a Patient Portal: Clinical Simulations to Investigate Patient Preferences

Johnson AJ. Easterling D ,et al.

hchen23

Neuroradiologist by trade, enthusiast for big data, digital marketing, 3D printing in healthcare

6 Responses

  1. That’s hectic! I feel that patients reading their reports before discussing it with a doctor is just plain dangerous and leads to unnecessary freakouts and Dr-Google-consultations. If radiologists are willing to discuss the reports with the patients that will be fine, but I know that at my hospital the radiologists are pretty overworked as it is and won’t be able to discuss with every single patient. We don’t have this option in South Africa, and for now I think it might be best…

  2. hchen23 says:

    Well said. I think a lot of us feel kind of stuck. This again demonstrates the impact that government policy has on the way medicine is practiced in the U.S. The newly available access to patient’s own electronic medical record is the result of Meaningful Use Stage 2….part of the Medicare and Medicaid EHR Incentive Programs
    http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

  3. eransch2013 says:

    Patients are already asking radiologists for second opinions on their examinations on webistes like http://www.diagnose.me, and they get a report that’s partly in lay language including some pictures with markers. They really appreciate this. We cannot ignore these changes and radiologists need to adapt to this. It’s all about putting the patient centrally.

  1. July 8, 2014

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