To Discuss Or Not To Discuss?

Sorry I haven’t written in a while. I have been busy making some interesting case and training videos for my free YouTube channel. Anyway, now that I’ve had the chance to sit on my tush and write something, I came up with an interesting topic. So this blog article has to do with discussing radiology results with patients. I’m not sure how you feel about this, but let’s chat.

Early on in my career as a radiology resident, we were told not to be doing this sort of thing, most of the time. The reasons made sense back then and for the most part, still do today. However, I don’t know if it’s just me or maybe most radiologists do this sort of thing, but I just can’t seem NOT to discuss results with a patient when I am doing a procedure on them.

First, I will give an example of times when we should not be discussing results and then I’ll go into how I approach every day practice. So the general theory of radiologists not discussing findings with the patient has several foundations. One is that we don’t know the patient anywhere near as well as the referring provider and we don’t know how the patient would take bad news. Would they go home and commit suicide if we told him they had cancer? Would they ignore the bad news and go jump on a plane and fly to Bali and spend the rest of their life in the sun having fun. I kind of like this second option. Anyway, that’s one of the theories; that we don’t know the patient all that well and shouldn’t be discussing results with them. OK, I get it. Yes, this is true for the most part.

So why else? Well there is also a theory that as radiologists, there is a general underlying belief by the primary care physicians that radiologists don’t have much of an impact on the patients’ understanding of their medical condition when we discuss the results with them. However, several studies have shown the opposite; that when patients are shown their medical images, this can lead to patients taking steps to reduce their risk factors or undergoing treatment or paying better attention to their follow up appointments. Some researchers have cited cardiovascular disease as an example, saying that CV risk is consistently underestimated by patients and their primary care providers, but when the images are shown to and discussed with the patient, most patients either say that the imaging consultation had a great impact or at least some impact on their level of understanding. 

Another example would be in the field of lung cancer screening. It is now known that when patients are shown that they have bad emphysema, a nodule or some sort of opacity on the CT scan, they are more likely to stick with a smoking cessation program and actually quit for good. That all sounds pretty good, right? 

Now let’s talk about an example of where radiologists discuss results with patients pretty frequently. Breast cancer. Often times, it is the radiologist discussing imaging findings of a mammogram with the patient and explaining to them why they need additional views of some sort of questionable finding on a screening study. In addition, the radiologists in many cases are calling patients directly with results of biopsies, either performed stereotactically or under ultrasound. This is a key role for radiologists in breast imaging because not only are they discussing the results of the biopsy, they are also discussing with the patient whether the biopsy matches the imaging findings, concordance vs discordance. Also, many times, the radiologist is advising what the next steps are, with regards to more imaging, perhaps MRI or pet CT, and making the referral to a breast surgeon and/or oncologist. So as you can see, breast imagers operate in their own unique space where they are very commonly discussing results with patients.

So after those examples, let me give you a taste of some of my day-to-day practice as a non-breast imager. I read a ton of CT’s and MRI’s and there’s no possible way I could be discussing every CT or MRI result with every patient. There are just too many of these studies performed in a given day for this to be feasible. However, if a patient were interested in having a sit down over results, that’s something that is perfectly understandable and easy to logistically schedule. To wit, I have patients calling me directly in the reading room to discuss a result at least once a month. OK so Doc, if you aren’t discussing CT’s and MRI’s with your patients most of the time, what things do you discuss? Well inner voice, thank you for asking and I’ll tell you. Most of the time it’s in the realm of procedures. For example, if I am doing an upper GI, my typical spiel after the case goes something like this, “Well Mr. Jones, I didn’t see much on this study, but I’m going to look at the images much more carefully on my computer back in the reading room and will be sending off a report to your primary care physician today.” Or something like, “Well Mr. Jones, it looks like you have a medium sized hiatal hernia with reflux that goes all the way up to your lower neck. I didn’t see an obstruction or narrowing. I’m going to look at the images again more carefully on my computer and send off a report to your ordering provider today.” That’s it. Nice and simple. And now the patient doesn’t have to be worried the whole time leading up to their follow-up appointment.

Here is another good example. How about a hysterosalpingogram or HSG? These patients are often pretty nervous about the findings and I don’t see much of a benefit in not telling them the results right away. Who knows how long they’ll have to wait for their referring physician to give them the results. So after the exam, I either tell the patient that their study was “completely normal” or something like, “The uterus is normal, the right fallopian tube is normal and we saw contrast spill into the abdomen, however the left tube is obstructed.” Often, I’ll go on to say that sometimes a physician can perform a minimally invasive procedure and try to open up that tube, which could increase chances of a pregnancy. Anyway, why should the patient wait around for days worrying about the results when I can just give them a few details to make them comfortable before they leave my facility. I have never had a patient tell me they wish I kept my mouth shut and so far, I have only gotten good reviews from patients about being so open and forthright with them. Not too shabby after being in the field for over 15 years.

So, how do your radiologists practice? Do you find that they are discussing results with their patients quite frequently or hardly ever at all? I’m not making a judgment either way, but it seems like we could offer patients in the field of imaging medicine some anxiety relief by being more personable and willing to discuss important details and results with all the wonderful patients referred to us by our colleagues.

As you can see, a certain level of communication skill is needed when speaking with patients. But what about your communication as a technologist with your radiology staff? Is that something you need some help with? Do you want to become one of the most desirable techs to work with at your institution? Well, I can help with that. Just go to www.CTSuperTech.com and check out my FREE COURSE which will get you started on your “Super Tech” journey.