In the tireless effort to enhance patient-physician communication, collect more (and better quality) data and improve cost-effective care, there has been very little discussion regarding enhancing the role of the radiologist in patient care. In fact, most articles about radiologists in mainstream media refer to the diminishing job market, the amount of unnecessary imaging and the growing practice of teleradiology. In a field that is facing increasing commoditization, a small-but-growing number of physicians are arguing for increased patient interaction in a historically isolated field.
Take for instance two recent studies in the prestigious American Journal of Roentgenology (the classic term for radiology) and Journal of American College of Radiology. The first evaluated the significance and impact of direct consultation between patients and radiologists following CT scans or ultrasounds of the body and pelvis. Of the 86 patients included in the study 84 (98 percent) found that reviewing the findings directly with the radiologist was very helpful and 99 percent reported that they will always want to review future examinations directly with a radiologist. While this may be alarming for those who argue that patients need a physician who knows the patient well and can provide the results within a broader context, it goes against not only recent research but my own experience as well.
I recently awoke one morning with a fever, an increasingly difficult time swallowing and voice changes. Lucky for me, my wife is also a physician, and based on a cursory brief examination and the clinical finding of a hot-potato voice, I was whisked off to the emergency room for further testing and observation in case the airway became more difficult to manage. A CT scan was deemed unremarkable by the emergency radiologist, and I was discharged after an observation period with a course of oral antibiotics and steroids. Later that day, however, I received an anxious call from an emergency physician. The ED doc had received a call from a neuroradiologist (who was referred to for finalization during normal business hours) who had noticed something. I was directed to come back to the ED that afternoon for further testing and an emergent otolaryngology consultation. By that time, however, I had begun to feel slightly better, and based on my developing symptoms did not consider them to warrant a repeat trip to the emergency room nor a surgical consultation in the coming hours. Lucky for me, I happened to know the neuroradiologist who read the study and called him directly. He was kind enough to explain his concerns in detail and offer a differential diagnosis (none of which demanded a same-day or emergency visit), and I scheduled a close follow-up with my primary care physician on an outpatient basis.
Now, I understand my experience is unlike 99.9 percent of all other patients. I had the privilege of speaking directly to my radiologist (rather than through a third-party middle man) and had an understanding of the differential and the relative acuities. However, what should be noted is that the emergency physician (even when speaking to another physician) did not feel comfortable offering a more thorough interpretation of the significance of the neuroradiologist’s addendum to the radiology report (nor do I think they should be tasked with that responsibility).
Is this not a perfect opportunity for mobile technology to empower patients and radiologists alike to cut costs, reduce patient anxiety and more fully create patient-centered care? While I think so, the vast majority of primary care physicians do not.
The second study examined perspectives of primary care physicians on the growing practice of radiologist-delivered results. What percent of primary care physicians felt that radiologists should deliver results directly to the patient? Zero. That’s right, 0 percent. However, 94 percent of the docs felt medico-legally obligated by recommendations made by radiologists within their reports. So, even though the radiologist should not deliver the results to the patient, the PCP is obligated to medico-legally make his or her recommendations.
Call me crazy, but if I was a patient and my PCP or referring physician was providing a recommendation, I would want to know full well the reasoning beyond medico-legal justification. I do not mean this as a slight to any primary care physicians (I come from a family of primary care physicians, so I need to watch my words) or referring providers in general, but I see this as a perfect opportunity for mobile technology to empower patients by directly connecting them with their results and to reinvigorate the field of radiology.
Share your experience or your thoughts on this growing practice below!
Zachary Landman, MD, is the chief medical officer for Doctorbase, a developer of scalable mobile health solutions, patient portals and patient engagement software. He earned his medical degree from UCSF School of Medicine. As a resident surgeon at Harvard Orthopaedics, he covered Massachusetts General Hospital, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center.