Talking to patients: Why should we?

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Dr. Bulas is Professor of Pediatrics and Radiology at the Children’s National Medical Center, Washington, D.C. She is currently the President of the Society for Pediatric Radiology. She is also a member of the editorial board of Applied Radiology.

“We must not forget we are, first, physicians, secondly, radiologists.” —WM Gilmore.1

Patient communication is not a top assessment when evaluating radiology residents in training. It’s not a top assessment when hiring a radiologist. But patient communication is at the core of medical practice. Good patient communication builds trust, helps to control patient expectations, reduces errors, and helps patients make appropriate health care decisions.

In the past there was clearer delineation of a radiologist’s responsibilities to the patient. Typically there was no need to talk to the patient.Results were reported directly to the referring physician. In many ways this was the most effective method of relaying information. Results can be complex and confusing and require understanding of anatomy, pathology, and physiology—knowledge that most patients do not have. Referring physicians often had long-term relationships with their patients and could put the results into context with regard to the patient’s entire health history.

However, in the era of social networking and personal health records, patients will have more direct access to imaging data and reports. Patient access will increase with the implementation of patient portals and personal health records.2 As practices get busier, efficiency becomes the priority, and less time is allotted per patient visit. Referring specialists may not be aware of the entire health history of the patient and not have a long-term relationship with the family. Patients will value any physician who spends time communicating with them. In a recent study by Basu et al., patients were surveyed for their preferences on how they receive results, from whom they receive them, and when they receive them. The majority wanted results communicated within a few hours of the study. Patients did not show a strong preference regarding which physician communicated the results, but speed was most important factor.3

Many specialties in radiology already have practices that routinely include direct communication with patients. Sonologists, fluoroscopists, interventional radiologists, women’s imagers, and pediatric radiologists often communicate directly with their patients before, during, and after examinations. These procedures typically include face-to-face contact, which strengthens the physician-patient relationship. As a fetal imager, I regularly counsel families following fetal magnetic resonance imaging exams (MRI) and sonograms. Despite the time this involves and the potentially devastating news that may be discussed, I have found this to be one of the most rewarding aspects of my work. A study by Brown et al. on the intersection of ethics and communication in prenatal imaging found that fetal imagers were often the best qualified to provide consultation with parents.4 Reviewing images with the families served as a critical function in increasing the autonomy of these vulnerable parents. By visually demonstrating anomalies that may be difficult to appreciate by ultrasound, radiologists empower families to understand subtle, yet potentially overwhelming, diagnostic findings.

The American College of Radiology Practice Guidelines for Communication of Diagnostic Imaging Findings discusses two situationsin which there is a “responsibility for communicating results of imaging studies directly to the patient and arranging for appropriate followup.”5,6 These include when a patient is self referred or referred by “insurance companies, employers, federal benefits programs and, in some instances, lawyers.” When a referring physician is unreachable and a significant finding requires action, the patient should be contacted to ensure that the best outcome is achieved, fulfilling our responsibility to the patient and helping to avoid potential liability.5,6 While there is little debate concerning the responsibilities of radiologists in these situations, the ACR has recognized the importance of moving beyond the traditional role of the radiologist as a physician’s consultant. The ACR’s “Face of Radiology” campaign wants to convey to patients that the “radiologist is the physician expert in diagnosis, patient care, and treatment through medical imaging.”7 In this age of radiation safety concerns, the presence of radiologists who are comfortable in discussing the risks and benefits of—and alternatives to—imaging studies may obviate the push for signed informed consent for procedures utilizing radiation.8

There are many reasons not to talk to patients—cost, efficiency, and referring physician preference, among them—yet there are many more compelling reasons to encourage communication. The public should understand the radiologist’s role in delivery of excellent healthcare. Direct radiologist-patient discussion can improve patient care by providing timely, accurate interpretations and by providing a method for patients to ask questions. It is the right thing to do.

References

  1. WM Gilmore. The radiologist as a consultant. Can Med Assoc J. 1940;42:357-360.
  2. Personal Communication. Nabile Safdar MD.
  3. Basu PA, Ruiz-Wibbelsmann JA, Spielman SB, et al. Creating a patient-centered imaging service: Determining what patients want. AJR Am J Roentgenol. 2011;196:605-610.
  4. Brown S. The intersection of ethics and communication in prenatal imaging: Challenges for the pediatric radiologist. Pediatr Radiol. 2010;40:514-517.
  5. American College of Radiology. ACR Guideline for Communication of Diagnostic Imaging Findings. http://www.acr.org/secondarymainmenucategories/quality_safety/guidelines/dx/comm_diag_rad.aspx. Accessed May 5,2011.
  6. Berlin L. Are radiologists contracted by third parties to interpret radiographs liable for not communicating results directly to patients? AJR Am J Roentgenol. 2002;178:27-33.
  7. American College of Radiology. ACR“Face of Radiology” campaign to educate public on what radiologists are and do. http://www.acr.org/MainMenuCategories/media_room/ FeaturedCategories/PressReleases/Archive/ACRtoLaunchFaceofRadiologyCampaign.aspx. Accessed May 5, 2011.
  8. Goske MJ, Bulas D. Improving health literacy: Informed decision-making rather than informed consent for CT scans in children. Pediatr Radiol. 2009;39:901-903.
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Talking to patients: Why should we?.  Appl Radiol. 

May 26, 2011
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