Why Can’t You Talk to Your Radiologist? (And Why Sometimes You Should)
When a doctor sends a patient for an imaging test, it can take hours, days and sometimes weeks for the patient to hear the results from the doctor who ordered the test. That’s nerve-wracking. So why can’t patients get this information sooner, directly from the radiologist?
That’s what Dr. Jennifer Kemp, herself a radiologist, wanted to know when her husband had cancer and got scans every three months while they waited each time for the results.
“I couldn’t believe how anxiety-provoking it was to wait even an hour,” she told the New York Times. “Sometimes he would get a scan I didn’t feel comfortable interpreting and he had to spend 24 hours waiting – and I had connections. That was absolute torture.”
So she did something that should benefit all patients, not just those with medical profession connections. She’s heading a committee of the Radiological Society of North America whose mission is to make radiologists more accessible to patients. That means giving them test results immediately if they are requested. Kemp does it, and gives her patients and their doctors her direct telephone number.
Most of us have had X-rays, ultrasounds or MRIs, and lots of times, the only person you meet is the technician who puts you in the machine. The radiologist, the medical doctor who writes the formal interpretation of the study based on looking at all the images, usually sits in a dark room in the back, or even many miles away. The standard procedure, engraved in stone practically since Marie Curie discovered X-rays, is for the radiologist’s report to go to the ordering doctor only, not to you the patient.
The Times reports that the American College of Radiology agrees with Kemp that patients now want to know how and why doctors make decisions about their care. The paper also says that an increasing number of medical facilities and doctors’ practices allow patients to access their medical records online, and such records often include imaging reports.
The move toward access is not about legally mandating radiologists to disclose information to patients, it’s about illuminating radiology practices that have done so successfully. It’s about practitioners informing their peers what patients want.
Still, as The Times points out, it doesn’t occur to a lot of people to ask to speak to a radiologist, and many referring doctors don’t seem to have a relationship with these specialists – they just give their patient a prescription for a scan and send them on their way. Some might recommend certain radiological facilities, but insurance coverage also figures into the choice of whom to use.
As always, some practitioners resist changing their ways. Some radiologists aren’t used to talking directly to patients, and can’t answer questions patients might logically ask after hearing the results of the scan. “A radiologist, despite an M.D. degree,” The Times explains, “cannot answer questions about drugs or surgery and without knowing the clinical history may not know if abnormalities are important. And would doctors even refer patients to a radiologist who blurts out a scan’s results?”
But many patients want to hear about their results, and with the exception of mammograms, how quickly that happens for an MRI, PET, CT or ultrasound, depends on the individuals – doctors and patients – involved.
Dr. Geraldine McGinty, chairwoman of the American College of Radiology’s commission on economics, told The Times that if a scan shows something really serious or unexpected, she tries to contact the referring doctor before telling the patient. “If this is not possible and the patient asks to speak directly with me, I’ll make the call to the other doctor as soon as possible, ideally before the patient leaves my office.”
Mammogram results usually are given to the patient right after the scan because the Mammography Quality Standards Act of 1992 requires women to get their results from the radiologist. The act says that if the scan suggests the patient needs a biopsy, the radiologist must discuss it face-to-face with her.
But many radiologists consider their jobs only to be working in dark isolation, reading scans and sending reports to referring doctors. Dr. Christopher Beaulieu, a radiologist at Stanford, told The Times that patients seldom ask to see their scans or talk to him or his colleagues. And if they do, “there is pushback” from radiologists and referring physicians.
Beaulieu says radiologists don’t have time to meet regularly with patients, and that they worry about having to deliver bad news. He also knows that some referring physicians, he said, “don’t want some radiologist telling them or their patients what is wrong or what to do.”
We understand that’s a difficult part of medicine, and that a radiologist isn’t qualified to address the typical “what’s next?” response a patient might have. But we believe that to demur from patient engagement is patronizing and dismissive, and communicating is part of the delivery of quality medical care.
As McGinty acknowledged, making radiologist-patient consultations routine requires a culture shift. That means radiologists and referring doctors need to establish their own relationships. It means radiology groups must perform some outreach, like posting videos depicting how radiologists should talk to doctors and patients.
If you are having an imaging test, and you want to discuss what the radiologist sees as soon as possible, tell your referring doctor that you want to know, and will ask the radiologist. Make your interests clear when you check in for the test. You also have the right to a copy of the scan, which often can be provided in an electronic format.
Usually, you won’t be able to see the radiologist in person, so ask to make a phone appointment. Otherwise, consider the approach of one source for The Times story. He has lung cancer and has had innumerable scans. At each imaging appointment, he asks for a copy of his scan.
Once, he wanted to discuss a scan report with the radiologist, but could never get the doctor to return his calls. “So I just went there,” he told The Times. “I found the guy’s office and walked in.”
“He seemed physically afraid of me,” he said, believing that the radiologist never saw patients, so, “his immediate reaction was to hit the panic button.”
But it’s your body, and it’s his job to talk to you about it.