Patients love the idea, and most referring physicians are on board. But radiologists don’t traditionally deliver results directly to their patients.
And why not?
“Certainly there are logistical challenges,” said Frank Lexa, MD, vice chairman and professor of radiology at Drexel University College of Medicine, who has done studies on the issue for private practice groups.
It’s time spent not reading studies, a shift in the practice work flow, one more thing to add to the day, and perhaps a bit outside of many radiologists’ comfort zones. Despite these hurdles, it’s an issue raised from time to time as studies examine the idea, and it’s a role that is increasingly being demanded of radiologists.
Indeed, Lexa asked, what does the job of the radiologist in 2020 look like? The healthcare industry is no doubt moving toward integrated delivery systems and incentives for quality and outcomes, he noted. There will be more ways to measure — and reward — outcomes, and patient satisfaction will be one of them.
“The other things we do besides reading films may become very important to a radiologist in an [accountable care organization],” Lexa said. There will be tasks bundled into the job, like talking with patients, that might not be directly reimbursed. “If you want to be a thriving part of an organization that is going to do well in 2020, you may well find yourself doing a mix of things,” some paid, some not.
Here’s another pro: It’s a chance to showcase your skills and your profession, and use those skills you received in your medical training. “There’s an opportunity for radiologists to show off who they are and have a face-to-face moment with the patient,” Lexa said. “Otherwise we are mysterious people who are behind the scenes.”
And studies are showing patients like the idea. Jay Pahade, MD, a faculty member at Yale University who completed his fellowship at Beth Israel Deaconess Medical Center in Boston, and colleagues sought to gauge patient preferences and their anxiety levels before and after direct consultation by a radiologist. They surveyed patients before and after a post-exam consultation with a radiologist.
In their study, presented at the RSNA annual meeting in Chicago in November 2011, researchers surveyed 86 patients undergoing either CT of the torso, CT abdomen/pelvis, or non-obstetrical / non-vascular ultrasound examinations. They found 82 percent of patients surveyed prior to the consultation said that they’d rather hear their results from both ordering physician and radiologist. After consultation, it was 91 percent.
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And after the consultation with the radiologist, 99 percent agreed that reviewing the exam with the radiologist was helpful, and 98 percent reported a desire to review or have that option in the future if they asked. Further, Pahade and his colleagues found that reported anxiety decreased in 48 percent of patients after consultation.
Pahade said his findings weren’t that surprising, and he’s always been a proponent of making radiology more patient-centered. “I think it would add value to what we do, and to the healthcare system, to empower our patients a bit more.
“Patients hate to wait for results,” he continued. “It makes more sense if we look to see if it’s feasible to have more patient interaction and provide results on the day of the exam.”
Now we get to the hurdles to making this a reality. Pahade pointed out a major one: time. In his study, the average consultation time for CT exams was 10.4 minutes and 7.1 minutes for ultrasound. That’s time not spent reading other studies, Pahade noted.
Lexa said that not every patient needs a long 15 to 20 minute discourse on a disease. It shouldn’t be too difficult to offer limited results, he said, telling patients that their referring physician will follow up with more information and consultation.
You also have to make sure your referring physician is OK with the idea. Referring physicians might have differing preferences, with some open to the radiologist assuming that role and others more protective of their patient relationship, Lexa said. “When I have done this at a personal level, the first thing I do is ask the referring doctors if they are OK with it,” he said. “There won’t be a blanket answer.”
And what about the argument that radiologists went into medicine thinking they could spent most of their time alone at a computer with little patient interaction? In most cases, that’s just a stereotype, and although there will always be people who fit that profile, most radiologists should be prepared to have a brief conversation with patients, Lexa said.
Indeed, the same debate was raised and settled years ago in the field of breast imaging. The Mammography Quality Standards Act requires radiologists to inform patients of their results. “We found a way, because it was the correct way to do it,” Pahade said of breast imaging results. “Patients like it and it was good healthcare.”
Similarly, there are radiology practices who are finding a way to deliver results. One example is Washington Radiology Associates in Washington, D.C., where radiologists routinely deliver results to sonogram and diagnostic mammogram patients.
“That takes about a minute; we’re in the room for a few minutes,” said Mark Klein, a radiologist at Washington Radiology Associates. In a typical half-day each radiologist might have such encounters with 15 to 20 patients. “For me, I may talk to 35 patients a day if I’m doing ultrasound.”
His practice used to also routinely meet with CT and MR patients, but that proved too logistically difficult. Still, whenever he can, Klein said he meets with patients to discuss results. “Now, if I do one at a site and the patient is there, I might say, ‘Hey, Mrs. Jones, I know you’re waiting, here’s what I see,’” he said.
Klein conceded that it’s impossible to see every patient, but there are certain areas of practice where it makes sense and it’s worth the time and effort. Pick an area or a time during the day or specific patients you want to follow up with directly, Klein said. Patients are deeply appreciative of that personal interaction, and may return to the practice when they need additional scans. That’s good business, Klein noted, adding his practice continues to be successful in a competitive market.
Ultimately, Klein said, it’s personally rewarding. To those who might hesitate, he said, “Understand you are missing an opportunity to enhance your practice, and the quality of your career. It’s the most rewarding thing you can do in medicine, even if you didn’t plan on it as a radiologist.”