PCPs say no to rads giving results to patients

Most primary care physicians (PCPs) are satisfied with radiology reporting and recommendations, according to results of a survey published Feb. 1 in the Journal of American College of Radiology. However, the survey offered a few surprises, including a universal objection to radiologists delivering results to patients.

“As radiologists propose measures to improve reporting, it is wise to obtain an understanding of the needs and opinions of referring physicians, particularly primary care physicians, regarding these measures so that their feedback and ideas can be incorporated into any change in practice,” wrote Andrew J. Gunn, MD, from the department of radiology at Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues.

Despite earlier attempts to improve radiology reports, the researchers noted ongoing dissatisfaction with radiology reports among referring physicians and patients. More recent initiatives to improve reporting and communication include direct communication of results to patients. However, PCPs’ opinions of this practice are not well understood.

Thus, Gunn and colleagues conducted an online survey of 229 PCPs to better understand their views on radiology reporting and results communication. A total of 100 physicians responded to the survey.   

Seventy-nine percent of PCPs were either very satisfied or somewhat satisfied with radiology reporting. When respondents ranked the most important component of the reports, the top selections were: diagnostic accuracy (39 percent), clarity of language (14 percent), detailed discussion of findings (12 percent) and recommendations for further testing or treatment (12 percent).

In addition, 95 percent of physicians said the referring provider should deliver results to patients, and no respondents thought radiologists should directly communicate results. “These findings run against the current trend of increasing the amount of direct communication between radiologists and both referring physicians and patients, which has been fueled by regulatory, legal, consumer and entrepreneurial forces,” wrote Gunn and colleagues.

The researchers noted their results parallel those of focus group and experiential data, which suggest referring physicians’ concerns that results communication by radiologists could confuse patients, increase anxiety and weaken the physician-patient relationship.

Although 65 percent of respondents were very satisfied or somewhat satisfied with recommendations within the radiology report, this level of satisfaction is lower than with reporting in general and poses some challenges. Specifically, 94 percent of PCPs felt medicolegally obligated by radiologists’ recommendations, which increased for 23 percent of respondents when set apart in an independent section of the report. However, use of qualifying language, such as “if clinically indicated” lessened the sense of medicolegal obligation for 58 percent of respondents.

In addition, while 36 percent of respondents identified too many recommendations for further testing and treatment as the most significant problem within radiology reports, 12 percent cited no recommendations for further testing and treatment as the most significant problem. A total of 19 percent identified unclear or nonspecific language as the most significant problem.

Gunn and colleagues offered several solutions to reporting conundrums. These are:

• Adding qualifying language to all recommendations;
• Instituting time during the day for dedicated consultation with referring physicians;
• Using “patient-friendly” language; and
• Including the radiologist’s email address or pager number on all reports to facilitate open communication.

Continuing improvements in radiology reporting are essential, and should consider the preferences of referring physicians and patients, concluded Gunn and colleagues.

Look for slides related to this survey in Health Imaging on Feb. 5.