AR: Talk is not cheapthe payoff + costs of patient communication

When patients are asked how they prefer to receive radiology results—either from their referring physician or directly from the radiologist—they seem to want things both ways. A recent survey has shown that about three quarters of patients prefer to hear results through the traditional model, from the referring physician, but a nearly equal proportion expect their results to come from the experts at image interpretation, according to a study published in the June issue of Academic Radiology.

“The discrepancy in these results is likely because there is persistent confusion as to the role of radiologists, with only 60 percent of respondents correctly defining radiologists as physicians,” wrote study author Melanie Kuhlman, MD, of the University of Arizona in Tucson, and colleagues. “There is the possibility that patients believe that their primary physicians are ‘experts’ at interpreting images.”

The findings were based on more than 200 returned surveys, which were provided to outpatients undergoing MRI or CT exams during a four-week survey period in February and March 2011.

For exams with normal results, 73 percent of patients preferred to receive results from the ordering physician. This percentage ticked up to 77 percent when patients were asked how they’d like to receive abnormal imaging results.

A total of 40 percent of patients believed radiologists were either technologists or nurses, not specially trained physicians, further underscoring the point that patients don’t fully understand the role of radiologists.

Patients also indicated they want results quickly, with 73 percent preferring the fastest possible method regardless of who actually provides the results.

Kuhlman and colleagues recognized the work of the American College of Radiology’s (ACR) Face of Radiology campaign designed to educate patients on the role of radiologists, but stressed that more needs to be accomplished.

“Despite the efforts by such institutions, including the ACR, to more publically outline radiologists' role in health care, radiologists' position continues to be undervalued and misunderstood. Our patients need to be educated on who the experts are in reading and interpreting their imaging exams,” wrote the authors.

Saurabh Jha, MBBS, of the University of Pennsylvania in Philadelphia, expanded on this point in an accompanying editorial, arguing that radiologists need to take a more visible role and tout the value they add to the healthcare process, especially at a time when healthcare costs are under scrutiny.

“It is a truism that the only time a patient knows his or her interpreting radiologist is when that radiologist's name appears on a bill for services generated,” wrote Jha. “In the era of ever increasing copayments, this is more likely to engender resentment than goodwill, particularly if a patient cannot associate a face to a name.”

Making the change to increase radiologists’ direct contact with patients will not be simple, explained Jha. It would represent a “paradigm shift” to the traditional role of radiologists as the “doctors’ doctor.”

Radiologists also might find that “the burden of clinical correlation will fall upon them,” wrote Jha. With more patient communication will come more responsibility to ask patients more questions, extract more information from medical histories and possibly conduct physical examinations. Reports will also have to be written in a patient-friendly way, avoiding terminology that might be common for physicians but causes anxiety in patients.

Finally, there are logistical issues that practices would need to work out. Direct patient communication takes time, which is itself a valuable commodity.

“None of the problems are insurmountable, nor do I suggest that they should not be overcome,” wrote Jha. “It is clear that direct communication of results to patients is a value-adding paradigm. However, there is no free lunch. There is a trade-off. In the enthusiasm brought about by a pressing necessity for change, one must be even more cognizant that details are not ignored or wished away.”