Communicating Imaging Results to Patients: OnSite Results
American Journal of Roentgenology
In the December 2007 issue of the American Journal of Roentgenology, Leonard Berlin asked, "Communicating Results of All Radiologic Examinations Directly to Patients: Has the Time Come?". Six months earlier, Metro Imaging had answered in the affirmative.
Metro Imaging, founded in 1994, has five full-service imaging centers in the greater St. Louis area. The patients who come to Metro Imaging for their examinations have always had a common concern: They all want to know, with more or less urgency, what their MRI, CT, or mammography examination shows. They ask, "When will my doctor get my results?" They beg our technologists to give them results and tell us that it can take weeks to get results from their referring physicians.
So in June of 2007, Metro Imaging began giving patients the results of their imaging examinations at the time of service. We branded our new service OnSite Results (OSR). Patients are given an OSR card on arrival at our office. They check "yes" or "no" on the card to signify whether they would like to receive the "preliminary results" of their examination. The card states:
These are only your PRELIMINARY RESULTS. The radiologist will send a written report to your physician about this exam. Your PRELIMINARY RESULTS do not rule out the need for further evaluation or treatment. You must follow up with your physician to learn the FINAL RESULTS and have your questions about this exam answered.
The card is then given to the technologist performing the patient's examination. On completion, the examination is reviewed by the radiologist, and the preliminary results are written on the card, either by the radiologist or by the technologist, as directed by the radiologist. The technologist then gives the OSR card to the patient.
The concept of "preliminary results" is more complicated than one might anticipate. We did not want to give patients results that they would not understand or that would needlessly alarm them. On the other hand, we did not want to "cheat" patients by giving them results that were meaningless or too dumbed down. We ended up giving findings that are more technical and complete than we had anticipated because that is what patients expect.
Our technologists found that they cannot give patients their OSR card and walk away. More often than not, they were asked to explain the results or answer questions. We trained our technologists how to explain findings and also ensured that they knew which questions not to answer. At times, enough discrepancy exists between the complexity of the results and the patient's ability to comprehend them that the technologist asks the radiologist to talk to the patient. In fact, we found in many cases that direct radiologist-patient interaction is preferable to giving the patient a card and that it is satisfying to both the patient and radiologist.
To give a patient a result of "normal" or "torn medial meniscus" is relatively straightforward. If a patient has something more acute, such as pneumonia or a fracture, our policy has always been to call the patient's referring physician, which we continue to do, in addition to writing the results on the card. If the patient has a more serious finding, such as an unexpected cancer, we attempt to reach the patient's referring physician. However, sometimes the radiologist is left to convey these results to the patient. Depending on the patient's level of sophistication, we either say that he or she has "a mass that needs further evaluation" or "a mass that is probably cancer." Although these results are not the ones that patients want to hear, they prefer knowing to not knowing and appreciate the process.
Although most of our referring physicians love OSR, we have received significant pushback from others. The most vocal physicians tend to be the ones who seldom refer to us. However, some physicians who refer significant numbers of patients to us asked us to stop giving their patients results.
We decided early on that we would not make exceptions to our OSR program for specific physicians. We told practices that they could instruct their patients to check "no" on their OSR cards and we would not give results. However, we also informed them that if their patients checked "yes," we would be obliged to give results.
The physicians who object to our OSR program do so for various reasons. Some believe they are better qualified to give results to their patients than we are. Some practices told us they want patients to come back to their office to get results so they can collect an additional copay. Some physicians are annoyed when they receive telephone calls from patients wanting to discuss the results we have given them. However, our OSR program has saved referring offices more telephone calls from patients than it has generated. In the end, we gained more referring physicians than we lost, and many whom we lost came back to us when they better understood the service we are providing to them and their patients.
On June 25, 2008, James H. Thrall, chair of the American College of Radiology (ACR) Board of Chancellors, posted the following on the ACR Blog:
In my experience, this practice [of giving results directly to patients] is not common. As physicians, we must be cautious in communicating results, so patients are ensured accurate information.
When radiologists communicate the results of imaging examinations directly to patients, we are indeed ensuring that patients receive accurate information. Referring physicians spend less and less time with their patients. Many use nurse practitioners as surrogates to provide various patient care functions, including giving patients the results of their examinations. Isn't the radiologist better qualified to provide this information?
Today's patients are active participants in the management of their health care. As radiologists, we should help patients to better understand the results of the examinations that we perform, so they can be educated participants in and make educated decisions about their health care.
At Metro Imaging, OSR is a success for all concerned. For the first 12 months after the start of OSR, our total volume increased by 7.7%. More importantly, we are providing our patients with the information and the peace of mind they are seeking. And they love it.
- Berlin L. Communicating results of all radiologic examinations directly to patients: has the time come? AJR 2007; 189:1275-1282
- Thrall JH. American College of Radiology Blog. http://acrblog.typepad.com/acrblog/2008/06/communication-w.html. Accessed December 26, 2008