Another argument for informing patients who request their results is that no one understands the imaging examination as well as the radiologist. In breast imaging, there has been a distinct transition in the reporting of results, which may foreshadow important changes in radiologist-patient communication across radiology (9). 258, No. 26, No. Sometimes an area of the body is included and can be evaluated using the images, but is not discussed. For example, radiologists could review imaging examinations while the patient waits and then ask technologists to inform the vast majority of patients who have normal or near-normal results. In the practice of US, Ragavendra et al (4) found that the average period of time necessary to inform patients of normal results was approximately 2 minutes. "Before you go to get a mammogram, make sure you know whether you're there for a screening mammogram or a diagnostic mammogram. The radiologist indicates whether each area was found to be normal, abnormal or potentially abnormal. 3, Journal of the American College of Radiology, Vol. At Iowa Radiology, we strive for excellence in everything we do. 113, No. Second, it is generally good for radiologists to inform patients of normal results, to alleviate unwarranted anxiety. 5, American Journal of Roentgenology, Vol. Radiologists are doctors who use X-rays, MRIs, CT scans, and other imaging to help diagnose and sometimes treat diseases. What does a radiologist do as a consultant? Consider the perspective of patients. These attitudes seem to vary somewhat from culture to culture. The process should not take much time and complete within 24-48 hours. Many patients think that radiologists merely perform tests, while their referring physician is the one who interprets them. The radiologist may know the imaging result but not grasp its full implications in this larger context (5,10). If a physician thought the patient did not need to know, or might be harmed in some way by being informed, the physician would not tell the patient. We did a survey to ask other Radiologists what degree they had when they became a Radiologist. An Observational Study of Postdiagnosis Management and Imaging Adherence, Making Time for Patients: Positive Impact of Direct Patient Reporting, Patients' Use and Evaluation of an Online System to Annotate Radiology Reports with Lay Language Definitions, Voices emerging from the shadows: Radiologic practitioners’ experiences of challenging conversations, An Asynchronous Online Collaboration Between Radiologists and Patients: Harnessing the Power of Informatics to Design the Ideal Patient Portal, Radiologist, obstetric patient, and emergency department provider survey: radiologist-patient interaction in the emergency department setting. If the examination result is abnormal, this fell to 87%. In a busy department that handles hundreds of patients each day, taking the time to ask every patient may slow throughput and delay the care of other patients. Find out more about what Radiologists do at work. Waiting more than a week when you know that the results are available to your doctor — but not to you — is excruciating and unacceptable. This is less of an issue if radiology results are conveyed to patients in a way that imposes a delay of hours or even days. Imagine patients whose follow-up imaging or biopsy takes place on a Friday. 2, 10 October 2013 | Journal of Digital Imaging, Vol. 46, No. 1, Journal of the American College of Radiology, Vol. No one “falls through the cracks.” The patient is always informed, alleviating the radiologist and referring physician of future liability due to breaches in communication (13,14). If patients still want to know, however, they have the right to wait or to receive a phone call once more definitive conclusions have been reached. At times, discrepancy can exist between the complexity of the results and the patient’s ability to comprehend them so the technologist might ask the radiologist to talk to the patient. A radiologist who wants to be considered a physician by patients and referring physicians cannot routinely say, “I am sorry Mrs. Jones, I know you would like me to tell you the results of your CT scan, but doing so is not part of my job description, and you will need to talk with the doctor who sent you here to learn what today’s test showed.”. In some spheres of radiology practice, the question is already settled. The radiologist is a doctor, and he or she is the one that interprets the results and writes the report. One of the best investments the field can make in its own future is increasing the commitment of radiologists to communicate directly with patients (18). One argument in favor of this approach is the fact that, for many patients in the radiology department, there is no preexisting relationship between the patient and the radiologist. We have Saturday appointments available for both MRI and mammograms to better meet your busy schedule. ACR Imaging 3.0 Preparedness: How Good are Your Communication Skills? Please still keep your doctor's appointment they may have additional lab results and would be important in the treatment plan. REs can do wonders for radiologists’ workflow, potentially bolstering the bottom line. This committee suggests that radiologists give results directly to patients when asked, either through an in-person meeting or over the phone. In some practices, radiologists may choose to delegate this responsibility to technologists. Should the sonographer? What if radiologists make mistakes in informing patients (such as false-positive results) that result in medicolegal actions (13)? Informing such patients is an opportunity to prevent suffering and promote the virtue of compassion. “A radiologist, despite an M.D. For one thing, radiology reports will likely follow the model of breast imaging and become more structured and standardized. 11, No. It is probable that these results would differ to an even greater degree in other countries, particularly in regions such as the Far East and the former Soviet Union, where the practice of informing patients of their diagnoses has been historically less prevalent (8). For example, a sonographer might tell a patient that hydronephrosis has resolved. In the future, more patients may also have direct and immediate access to their own electronic medical records, including radiology reports, so it will no longer be up to radiology staff whether or not to make the information available. An infant with a history of prenatal hydronephrosis is found to have a normal renal sonogram. Diagnostic radiologists use a variety of imaging procedures to see inside the body and assess or diagnose the patient’s condition. 3, Journal of the American College of Radiology, Vol. Communicating results of all radiologic examinations directly to patients: has the time come? Those who argue against radiology personnel informing patients are not necessarily arguing that patients should not be informed. 3, 29 January 2018 | Radiology, Vol. Referring physicians rely on the radiologist to catch the slightest inconsistencies and make conclusions about a diagnosis while keeping in mind the patient’s health history and other notes provided in the … If radiologists do not take advantage of such opportunities to communicate with patients, they lose control over what patients are told. First, if all patients are informed of their imaging results, failures to communicate results are eliminated. A final approach is to inform all patients of their results, whether they ask or not. Here are the results. a survey of radiologists’ and clinicians’ preferences, Disclosure of diagnosis in ambulatory radiology practice: expectations of patients and referring physicians [in German], When cultures clash: physician, patient, and family wishes in truth disclosure for dying patients, Direct disclosure by radiologists of imaging findings to patients: a survey of radiologists and medical staff members, Radiologists’ responses to patients’ inquiries about imaging results: a pilot study on opinions of various groups, Cleveland Clinic Pediatric Radiology Web site. ... "to see how we can do better." Independent Imaging offers the most advanced and sophisticated imaging technology available. Older patients and patients from other cultures may simply assume that they cannot get the results at the time of testing. 6, 15 June 2013 | Journal of Digital Imaging, Vol. Multiprovider and Patient Perspectives on Conveying Diagnostic Imaging Investigation Results in a South African Public Health Care System, Radiology Trainees’ Comfort With Difficult Conversations and Attitudes About Error Disclosure: Effect of a Communication Skills Workshop, A survey of the current status of coronary CT angiography using 64-slice multidetector CT in Taiwan, Strategies for Radiology Reporting and Communication Part 3: Patient Communication and Education, Strategies for Radiology Reporting and Communication. If you're there for your annual screening mammogram, you may not meet with the radiologist or get your results the same day. Yet, saying that the patient should be informed does not necessarily say who should do it. Some problematic and disturbing scenarios are possible. 8, No. It is both a responsibility and a privilege for radiologists and radiology personnel to play a role in communicating imaging results to patients. One of the best ways physicians can enhance patient-physician relationships is, at the end of an encounter, to ask patients if they have any questions (20). What if patients informed of their results by radiologists turn out to be less likely to follow up with their referring physician? American Medical Association Council on Ethical and Judicial Affairs, The state of radiology in 2006: very high spatial resolution but no visibility, The face of radiology. A mammogram is an important screening test for breast cancer that usually only takes about 30 minutes. Enter your email address below and we will send you the reset instructions. They simply assert that the radiologist and radiology personnel are not the ones who should do it. Should radiology department personnel, including radiologists, nurses, technologists, or clerical staff, provide results of diagnostic imaging studies to patients or their families? In general, it is good for radiologists and referring physicians to know one another well enough to know how to handle such situations in advance. Moreover, many studies of patient preferences tend to omit important confounding factors, such as the degree of familiarity between patient and physician, as well as other hurdles such as language and cultural barriers. Why should patients be forced to wait anxiously for hours, days, or potentially even weeks before finding out what the radiologist already knows? 8, Journal of the Formosan Medical Association, Vol. How soon will my personal doctor know the results of my exam? 33, No. 9, No. Once you have graduated from medical school, you will need to complete a four year radiology residency. 35, No. Make it clear that you want to know the results — even if everything’s OK. As with imaging test results, your doctor may not be able to get back to you right away. Levitsky et al (6) found that if the results are normal, 89% of radiologists and 76% of referring physicians say the radiologist should provide the information. 100, No. 4, American Journal of Roentgenology, Vol. Your doctor will explain the meaning of your test results and what to do next. Broadly speaking, radiologists can adopt one of four approaches to informing patients. In what follows, we briefly review the arguments for and against each of these alternatives and offer our own perspective. Especially in the case of language and cultural barriers, an offer by the radiologist or radiology personnel (operating where necessary with an interpreter) may go a long way toward alleviating patient anxiety and enhancing trust in the institution and health care system. 199, No. Why should such patients endure a miserable, sleepless weekend before getting their result on Monday? It may also decrease productivity and adversely affect compensation, inasmuch as radiologists who do a great job of communicating with patients are not compensated more than radiologists who avoid doing so. In the case of a catastrophic finding that requires immediate treatment, the American College of Radiology guideline for communication advises radiologists to contact the referring physician immediately (21). 3, 1 January 2011 | Radiology, Vol. Radiologists discussing test results with patients, a subject that has been lurking under the radar for a while, recently came to light because of an article in the New York Times. The findings section lists the radiologist’s observations and findings regarding each area of the body examined in the imaging study. Radiologists write up the results of their studies in detailed radiology reports. The subject of informing patients of the results of their imaging examinations has received intermittent attention during the years. Decades ago, when medical practice conformed to a more paternalistic model, it was more common for physicians to tell patients relatively little about their conditions, and the responsibility for determining what patients should know was understood to rest with the physician (1). Instead, they are healthcare professions who perform the imaging scans. By contrast, many referring physicians, particularly those in primary care, may have a long-standing relationship with the patient and thus have a better context for supplying such information. In personally informing patients about their test results, radiologists enjoy an immense opportunity to promote patient understanding, comfort, and trust in radiology. Two of those years will be spent in the classroom, while the other two will be spent doing clinical rotations. 13, No. 4, Journal of the American College of Radiology, Vol. For the moment, however, this decision is still largely in the hands of radiology department personnel, and it is important for all radiologists to think through the advantages and disadvantages of communicating more openly with patients. The American College of Radiology (ACR) is making a similar case. There are a number of arguments for telling patients the results of their radiology examinations when they so request. You will be cared for by highly skilled technologists and the finest radiologists, who will put you first. What is the need for follow-up examinations (16)? After this, your physician follows up with you about the results. Hence the patient should be able to get his CT scans on a CD on request. Few physicians would want a colleague to withhold such information from a relative or friend, and what physicians would not want others to do to them or their loved ones, they should not do to others (19). Of course, such an approach is not necessarily empowering if the patient has explicitly requested not to be informed, in which case the radiologist needs to choose between a policy of informing every patient and respecting the preferences of a particular patient (5). If radiologists want to argue that their professional responsibility extends no further than performing radiologic examinations, interpreting the images, and … To some, the approach of always telling every patient the results of their radiology examinations may seem to go too far. Dietitians and Nutritionists. Having an eye for detail and a great memory is essential for interpreting these results. Sometimes, there's an advantage to this. Faced with such challenges, radiologists may choose to delegate responsibility for informing many patients to other personnel, such as sonographers or nurses. Uncertainty can be very unpleasant, particularly for patients who are worried about an important diagnosis such as the fate of a pregnancy or the possibility of cancer. After reading the results of the medical images, the radiologist will consult with the primary care doctors who referred the patient for the testing. 12, 10 March 2016 | Emergency Radiology, Vol. 23, No. When the findings are uncertain, radiologists can always tell the patient that there are many images to interpret and that, rather than render a hurried opinion, they want to sit down and go over them carefully to make sure not to miss anything. This shows referring physicians that radiologists value their professional advice and also helps to build a better relationship. For example, the Mammography Quality Standards Act requires radiologists to inform patients of their mammographic results within 30 days (3). In some cases, referring physicians may want to see the patient in their office. Furthermore, the radiologist may have any one of a number of reasons for not informing patients. Our imaging services include: Want to know more about your test and what we are looking for? 10, No. Radiologists discussing test results with patients, a subject that has been lurking under the radar for a while, came to light a while ago because of an article in the New York Times. Reviewing Imaging Examination Results With a Radiologist Immediately After Study Completion: Patient Preferences and Assessment of Feasibility in an Academic Department, Becoming a Clinical Diagnostic Radiologist: The Answer Is Not “Clinically Correlate”, Communication of Findings of Radiologic Examinations: Medicolegal Considerations, Doctor-patient communication in radiology: a great opportunity for future radiology. Ultimately, however, every patient has the right to a direct consultation with the radiologist. American College of Radiology, Patient communication: what to teach radiology residents, Getting the most out of the clinical encounter: the four habits model, ACR standard for communication: diagnostic radiology, http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/default.html, https://www.cchs.net/onlinelearning/trnmnu.asp?roleid=152&;CaseID=109&;presid=2191, http://www.mypatientconnection.com/Articles/NeimanLetter.aspx, What Happens after a Diagnosis of High-Risk Breast Lesion at Stereotactic Vacuum-assisted Biopsy? You should have the mammogram results … In the case of a minor abnormality, 5 minutes was required. Log in. Radiologists have the training and education necessary to interpret the complex images provided by the radiologic tech. Communicate examination results or diagnostic information to referring physicians, patients, or families. What if patients begin asking radiologists questions about their diseases, prognoses, and therapies that radiologists are ill equipped to answer (5,6)? An extreme variant on the latter approach would be to inform even patients who state that they would prefer not to know. One is that doing so responds to a direct request from the patient. 1, Patient Education and Counseling, Vol. 2,3 As radiologists, it is time that we look at this issue with renewed diligence. 4, 19 March 2012 | La radiologia medica, Vol. This is one of the reasons that informed consent forms have become ubiquitous in health care (2). If the address matches an existing account you will receive an email with instructions to reset your password. Usually, results are delivered to your physician within 24 hours of your exam. The American Medical Association holds that physicians should deal openly and honestly with patients at all times. 2, Journal of the American College of Radiology, Vol. This is well-illustrated by the concept of reporting our results directly to the patient. Suppose the infant with a history of prenatal hydronephrosis is found to have a renal mass, and the findings in the patient with vaginal bleeding are consistent with fetal demise. Again, the American Medical Association’s Code of Medical Ethics is clear on this point (15). In an age that acknowledges patients’ right to inspect their own medical record, and with the growing implementation of electronic medical records, it is essentially futile for physicians to attempt to withhold such information (16). Things to know about radiologists. Before you can become a radiologist, you will need plenty of training. If radiology is to thrive in the future, the field needs to ensure that more radiologists also regard it as an important professional opportunity. They pretty much know what they’re looking at but aren’t responsible for interpreting results and are not allowed to tell the patients what they see. While most such communication problems represent a simple failure to communicate, in some of these cases, efforts to communicate have gone awry. Once the radiologists read it, the results are transcribed and sent to your physician. 104 views View 4 Upvoters Radiologists know the indications, limitations, risks, and implications of imaging test results better than referring physicians and patients. Physicians cannot always grant every patient request, but in this case, doing so provides the radiologist an opportunity to give patients something they naturally want and need and thereby helps to build a stronger relationship with the patient (5,6). After all, in performing and interpreting results of an imaging examination, radiologists enter into a form of physician-patient relationship with their patients. 210, No. Whether radiologists themselves always provide the results is another question, but the American Medical Association’s Code is clear that radiologists cannot always or even routinely refuse to provide results to patients who request them. 12, Journal of the American College of Radiology, Vol. They operate various types of equipment and scan devices and also guide patients through the scanning process to … Accurate results . A third is to inform any patient who asks, but when patients don’t ask, to ask them if they would like to know and inform those who respond affirmatively. Ductal Carcinoma in situ ( DCIS) is quite often discovered by the radiologist due to certain patterns of microcalcifications on the mammogram. Explore other careers. For one thing, some patients may not even know that finding out the results is an option. More recently, with the rise of patient rights and the principle of autonomy, it has become less common for physicians to withhold information from patients. 1, © 2020 Radiological Society of North America, Disclosure of results of sonographic examinations to patients by sonologists, Disclosure of imaging findings to patients directly by radiologists: survey of patients’ preferences, How should radiologists reply when patients ask about their diagnoses? When the abnormality was severe, the time required was 8 minutes. One objection to this policy is that radiologists and radiology personnel simply do not have time to inquire of all patients whether they would like to receive their results. Some radiologists may feel uncomfortable interacting with patients (11) and may have chosen careers in radiology in part to avoid such encounters. Radiographers operate medical imaging equipment, but they do not interpret the results. A 3-D mammogram may take a little longer. Author stated no financial relationship to disclose. For example, Lorch and Scherer (7) found that in Germany only 48% of surveyed patients would like to receive their results from the radiologist, with 58% saying they would like to get their results from the referring physician. These reports themselves can differ considerably from one radiologist to another; in essence, a “good” radiologist is one who avoids listing false positives in their reports, while catching any abnormality that could indicate a greater health concern. The Declining Radiology Job Market: How Should Radiologists Respond? Even if the results are complex and perhaps bring bad news, you can start making a plan of action and arrange to see your doctor in person for a more complete discussion. Images may be obtained with x-rays, (CT scans or radiographs), nuclear medicine (involving radioactive substances, magnetism (MRI), or ultrasound. In general, moving down this list means informing a progressively higher percentage of patients. A major cause of litigation against radiologists is failure to effectively communicate results. Part 1: Challenges and Heightened Expectations, Enhancing Patients' Experiences in Radiology. The radiologist can point out the findings on the images and talk about what they mean. While in many practices only a small minority of patients are likely to have a severe abnormality, this still can be a substantial drain on time. A specially trained doctor called a radiologist will read the results of your MRI and send the report to your doctor. When patients ask questions to which radiologists do not know the answer, it is best to say, “I don’t know the answer to that, but I think your referring physician (or someone else) will.” When unexpected or alarming findings are encountered, radiologists can always contact referring physicians to find out how they would like to handle the situation (6,12). 41, No. Is additional imaging indicated? When your referring doctors tell you they have reviewed your studies, what they usually mean is that they have reviewed the radiology report or gone over the imaging exam with your radiologist. In others, they may choose to come to the radiology department, and they may request that a colleague, such as an oncologist, join the conversation. Should radiologists and/or their designees be the ones to tell patients the results of their imaging examinations? 3, Journal of Medical Imaging and Radiation Sciences, Vol. However, if results are severely abnormal, only 33% of radiologists and 28% of referring physicians think that the radiologist should provide the information. Patients have a right to obtain information about their care from their physicians. Your Radiologist Has the Right Training, Knowledge, and Experience. A radiologist is a physician or medical specialist trained in obtaining and interpreting medical images. In 1998, Ragavendra et al (4) found that 84% of patients would prefer to receive results from the radiologist. Journal of Thoracic Imaging, Vol. 3, American Journal of Roentgenology, Vol. However, there are arguments to be made on its behalf. degree,” The Times explains, “cannot answer questions about drugs or surgery and without knowing the clinical history may not know if abnormalities are important. Radiologists need to be organized in their approach to providing timely information (7). Some radiologists aren’t used to talking directly to patients, and can’t answer questions patients might logically ask after hearing the results of the scan. Being a physician means accepting the responsibility of informing patients about important health issues, and this responsibility is in no way diminished simply because a physician prefers to avoid interacting with patients. If the results are mildly abnormal, 81% of radiologists and 57% of referring physicians opt for the radiologist. 2, American Journal of Roentgenology, Vol. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. In other areas, however, the answer is not so clear. This situation typically means that the radiologist did not find the area noteworthy for comment.Example: 1. Even radiologists who have no qualms about interacting with patients may feel uneasy or unqualified when it comes to breaking bad news (5). If the referring physician is unavailable, the patient should be contacted directly. Communicating findings of radiologic examinations: whither goest the radiologist’s duty? By examining the arguments for and against each of these approaches, radiologists, radiology department personnel, referring physicians, and patients can gain a deeper understanding of the basic issues involved in results disclosure and make more informed judgments. 215, No. Medical results should belong to the patient and not to the health services provider. On average, this process happens within 24 to 48 hours (depending on the complexity of the images). Or should the results be conveyed to the patient later by the referring physician? Interestingly, however, 75% of German patients surveyed said they would like to be informed of the results within 30 minutes. Systems improvements, such as getting radiology reports to referring physicians in a more timely fashion, might also make it more feasible for referring physicians to provide results. Could any ethical physician seriously suggest that patients do not have a right to know their own medical status? Whether radiologists themselves always provide the results is another question, but the American Medical Association’s Code is clear that radiologists cannot always or even routinely refuse to provide results to patients who request them. Imaging test is a part of your plan after which the reports will be send to the physicians and results will be given. 117, No. A pregnant patient with a history of vaginal bleeding has normal findings at examination. Does Direct Radiologist-Patient Verbal Communication Affect Follow-Up Compliance of Probably Benign Assessments? Part of the problem with radiology reports arises because we do not really understand how important this document has become to the non-radiologist caregiver. The idea is that patient anxiety while waiting to find out a test result could … Furthermore, it may reduce the rate of error in the communication of results, because radiologists and radiology personnel are best equipped to point out and explain imaging findings (16). “In an ideal environment, of course, patients would want to know results instantaneously,” Davenport said. Even those who think they could ask for results may be reluctant to do so, yet eagerly accept the invitation when offered it (4). One is to refrain from providing results, even if patients ask. When you need results faster than that, Radiology & Imaging provides them. Was required intermittent attention during the years do radiologists know results, however, the Mammography Quality Standards Act requires radiologists to all. 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