Empowered patients may challenge radiologists' authority

The concept of patient empowerment has existed in Western medicine for quite awhile. The Internet and the information revolution have provided patients with more knowledge and control over their medical data and health. Until now, most radiologists could assume that their position as interpreters of obscure cross-sectional images kept them immune from the trends patient empowerment has engendered.

That is no longer true. Digitized radiologic images will soon become fair game for patients seeking to understand their medical conditions, and medical imagers will begin to experience the trickle-down effects of patient empowerment.

Consider a report from this year's European Congress of Radiology: An Austrian radiologist described what happened when he gave patients access to their radiologic images and medical records. Managing access to medical records via the hospital's PACS had become unwieldy, and Dr. Peter Kullnig thought it would be better to let patients decide who should be authorized to review them. Patients began reviewing their own medical records and images.

"We realized from the log files that up to three-quarters of patients accessed their own images at least once," he said.

Kullnig's approach could become the standard operating procedure in Austria. The government-based insurance program plans to create online patient accounts containing comprehensive medical records, each accessible to individual patients. SMART cards imprinted with medical information, including radiologic images and medical data such as lab findings, are being issued to patients. Online availability may soon follow.

Similar plans for managing patient data have been proposed in the U.S. But even if patients don't obtain ready access to their medical records and images, other factors highlighting the care process could affect radiology. In a May Diagnostic Imaging column ("Hospital prices crawl out of their dark crypts," page 64), Dr. Eric Trefelner described a California law (based on one in Arizona) that will require hospitals to more fully disclose charges. The law will inevitably promote price competition among hospitals. Their radiology departments could feel the effects, possibly in added pressure regarding charges and through lower (or higher for those that are successful) procedural volumes.

Newly empowered patients could soon shop hospitals-and their radiology departments-based on price. Patients might also consider quality measures such as procedural volumes, maintenance of certification, degree of subspecialization, and perhaps even CME activities. They could use information services to find screening studies for cardiovascular, colon, and lung conditions, in addition to mammography.

There is some evidence that patients are already shopping for particular types of technology. At the DI offices, we frequently receive requests from consumers looking to find a particular type of scanner or asking which scan is best for a particular condition. One recent caller asked if there is a hotline that would help locate the nearest 3T MRI machine.

For the time being, radiologists can be secure in the knowledge that they understand the images and the technology better than patients and referring physicians do. But it would be dangerous to assume this will always be the case.

The patients who accessed their images in Austria probably did not fully understand what they saw, but image databases are also finding their way to the Internet. Just as radiologists search textbooks or online sources for comparable images, patients will do the same.

One day you may find yourself defending an imaging finding to a patient or explaining why a 1.5T scanner will provide just as much diagnostic information as the 3T scanner the patient requested .