How to Offer Value When Nobody Seems to Want It

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 - David M. Naeger, MD
David M. Naeger, MD

For years, radiologists on the vanguard have been telling us that we should consider relaying radiology results directly to patients.  We already do this in women’s imaging in the form of mammography patient letters, but there is much more room to continue this practice.

The reasons to consider communicating directly with patients are many: We are the imaging experts, and, in many ways, no one is better suited to explain the findings and interpretation of an imaging examination. By directly engaging patients, we also have the potential to increase their participation in their care and help our referring colleagues in the challenging and time-intensive process of relaying test results.

Beyond the above benefits, some authors have argued we must communicate with patients to improve radiologists’ visibility and highlight our expertise and  value. In an era of dropping reimbursements and ever-present turf battles, being an invisible cog in the machine of medicine does not help our cause, they argue.  Further, many have pointed out that the shift towards value-based payments will likely involve metrics that rely on more communication from radiologists with patients and referrers.

Most of the counter arguments for having greater communication have been voiced from within the field of radiology itself. Increasing communication takes more time away from reading studies, many argue. Also, radiologists are not in a position to provide the full conversation that patients desire, including a full analysis of how their imaging results fit with their symptoms and the next steps in management.

While there is ongoing debate within radiology about the best course of action, my colleagues considered a different question: “Do patients even want to hear results from us?” This led us to perform a large survey of patients presenting to our university hospital and an affiliated county hospital for imaging, for which the results were recently pulbished.(1)

Interestingly, when patients were asked if they would prefer to hear results from a medical imaging expert who they have not met before, or their doctor who is not an imaging expert but can answer questions about treatment, patients picked their doctor. We also asked the question another way, presenting the surveyed patients with a list of theoretical ways of receiving their radiology results—most (63%) selected models where they heard the news through their doctor.

Unexpected results

These results surprised us. Though they were told whom the imaging experts are, patients preferred the information to come second hand. It seemed issues of familiarity were at play, as well as the desire to discuss the “next step”. While not assessed, we also wonder if the role of radiologists remains too obscure for patients to value it and seek it out.

We asked some additional questions in our survey. For example, we learned that most patients (64%) wanted access to their radiology reports and even more (85%) wanted to be able to see their images when learning the results.

We believe these results indicate that there is work to be done. If patients do not wish to receive at least some information from the physicians who understand imaging the most, our role is probably not sufficiently understood.

Making imaging reports readily available is a start; the radiology report is signed by a radiologist, thereby making our role more visible. Making reports easily available also ensures patients have access to the information that informs their care, so they can ask appropriate questions and learn more.

What the future holds regarding direct communication is not clear, but it is clear that we must continue to increase our visibility and highlight our expertise. We must help meet the needs of patients and referring providers alike as the world of medicine evolves.

For the time being, there are a number of steps we can take. In addition to making reports more readily available, practices can provide a number for patients to call to ask questions or learn more. Also, we all can continue to communicate regularly with our referring providers, including relaying urgent results, discussing difficult cases and participating in tumor boards and multidisciplinary conferences.

Consider taking that phone call the next time your front desk alerts you that a patient is on the phone. Radiologists have an incredibly important role in medicine, and patients are better for it. We should not allow that fact to remain a secret.

David