Daily Bulletin 2017

The Doctor's Doctor or the Patient's Physician: Can Radiologists Simultaneously Be Both?

Friday, Dec. 01, 2017

In a point-counterpoint session Wednesday afternoon, a panel of medical imaging specialists debated whether radiologists can serve both patients and referring physicians at the same time.

Pictured left to right: Cook, McGinty, Jha, and Hawkins

Panel moderator, Tessa Cook, MD, PhD, from the University of Pennsylvania, Philadelphia, opened by stating, "Patients often want the ability to interact with the radiologist who interpreted their exam, if only to ask a question. However, are radiologists ready to do this and, if so, should we only speak to a patient once we have reviewed their medical history and/or had a discussion with the referring physician?"

Geraldine McGinty, MD, MBA, of Weill Cornell Medicine, New York City, agreed that radiologists should speak with patients. "Patients need to see radiologists as one of their physicians. Why would we expect patients to understand the value of radiology if they never see or talk to us?" Dr. McGinty asked. "However, speaking to patients should be a coordinated and collaborative effort between the radiologist and referring physician to ensure that the information is given in context."

Saurabh Jha, MD, of the University of Pennsylvania, agreed that radiologists and referring physicians need to work more closely together, but didn't agree that the radiologist should speak with patients. "Referring physicians have referred to imaging for a specific reason, but imaging is just a glimpse of that patient," Dr. Jha said. "Without access to the whole patient story, it is our job to guide the physician, not to guide the patient."

The question that should be asked is, "Are radiologists willing to do the hard things required to become trusted members of the clinical care team?" according to C. Matthew Hawkins, MD, of Emory University Hospital, Atlanta.

"Building trust among the other members of the clinical care team will eventually lead to the ability to talk with patients, but not before," Dr. Hawkins said.

Setting Expectations Benefits All

All the panelists agreed that it would be appropriate to ask patients if they want their results during imaging, but with caveats.

"I think a patient with a long medical history, who, for example, has a cancer recurrence after a long remission, will probably want to hear from their physician, who has been with them through their entire illness," Dr. Hawkins said.

Regarding asking patients about their preferences, Dr. Jha added: "It is fine to ask the patient if they want their results, but we should also ask them if they want it from the expert in imaging, because they may not."

Dr. McGinty agreed that it should be clear that the results can come from the radiologist or the referring physician. "It isn't easy when a patient is seeking reassurance quickly, but you know that you need more time to review an image, talk with the referring physician or look more carefully at a medical history," Dr. McGinty said. "In these instances, I let the patient know that."

The panelists agreed that the radiology report is valuable and that the system needs to change in some way to ensure that both physicians and patients understand what the radiologist can provide. Dr. Cook concluded, "No matter if the radiologist speaks directly to the patient or through the referring physician, these interactions need to occur in a very meaningful way."

Tip of the day:

Some fabrics include metallic threads that can cause artifacts and patient injury in MRI. Change all MRI patients into facility-provided gowns.

The RSNA 2017 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.