17 Nov Radiologists Tell The Story Of A Patient Through Pictures

The following is a true patient story:
68 yo male presents to his primary care physician due to complaint of radiating back pain on the right side, lower flank. 4 weeks prior patient had a full check up and yearly exam, clean bill of health, with exception for diabetes mellitus that has been controlled for previous 4 years by diet and exercise. Primary care physician orders an ultrasound. Results are a finding in the right ureter. Labs ordered. Creatinine high. Patient asked to go home, push fluids, and come back on Monday for labs. Patient returns, lab drawn, creatinine still high. CT without contrast ordered. Findings of CT: right ureter is obstructed. There is also a mass found in the pancreas.
Upon returning to the primary care physicians office to discuss the above findings, the patient asks, “Doctor, how will we proceed? What other images should we consider?”
The primary care physician honestly responds, “I am not sure. This is not my area of expertise. I think we should refer you to a medical oncologist. They will know how to work you up from this point.”
Patient, looking puzzled, asks, “Are you saying I have cancer?”
Primary care physician responds, “We do not know what you have. This is beyond my expertise.”
The above situations are common in healthcare. I can guarantee that they occur on a daily basis in just about every corner of the U.S. in all healthcare organizations.
Part of it is due to the increase in number of patients being covered and having access to primary care physicians. Part of it is due to the number of healthcare organizations merging, being acquired, and in consolidation of other hospitals and clinics. You add in the declines in reimbursement, physician pressures from administration for efficiency, and then a component of physician pay based on production (number of patients they see per day/hour) it means that primary care physicians, family doctors, physician assistants, and nurse practitioners do not have the time to do complex and time consuming workups.
A case such as the above may make perfect sense to be referred on to a more specialized team to work the patient up most appropriately.
However, not once in this story was a radiologist ever mentioned. A radiologist was never consulted for their expert opinion.
Now this does not surprise me since it is common place in the vast majority of healthcare organizations. However, I challenge and ask why is this status quo okay? Why is it acceptable? Why is the healthcare system set up that radiologists perform exams ordered by other physicians and rarely are consulted or asked for their professional opinion on the best way to image a patient?
Let’s make this very simple. If you need surgery you go to a surgeon. If it happens to be a special surgery, say on your heart, you go to see a surgeon that only operates on hearts. If you need treatment for cancer, you go to see a medical oncologist for chemotherapy and a radiation oncologist for radiation therapy.
So why is it that when patients need images, that every other physician thinks they know what is the best option, test, or procedure to order to obtain the information they are seeking. Why?
There are a lot of excuses or rationales as to why this occurs. Frankly, I have my own definition of the problem, and I want to spend my energy on changing it.
If we want to place the needs of patients front and center then we need to elevate the role of radiologists. If we want to move from a world of “Fee for Service” to a world of “Fee for Value” then a sure fire win is in consulting and having a dialogue with the radiologists before ordering imaging tests.
One of the pain points for patients is the incessant return to radiology. I already had an X-ray. I just had a CT Scan. Why are you doing another Ultrasound? I had a CT on Monday and know you want me to come back for another one, and then an MRI? Why?
Now, in some situations, there is a process that has been established by national guidelines from various medical professional associations. However, not all associations agree with one another, and not all of them work closely with the American College of Radiologists, the ACR.
I believe that taking a few extra moments to contact and discuss with a radiologist what is the best imaging study to order for a specific patient would make a huge impact.
1. It would probably save repeat exams being ordered in radiology.
2. It would improve the patient experience because the likelihood of a patient getting the right exam, at the right time, and obtaining the right information would increase.
3. Ordering physicians would be happier since they know that they are ordering the right exam and getting the answers to the questions they have in regards to their patient.
4. The value equation would not just be from the healthcare organizations perspective, but it would now begin with the patient. It would also include the ordering physicians, radiologists, billing departments, and insurance payers.
5. In bringing the expertise of radiologists to the forefront, it promotes further collaboration amongst the healthcare team. It drives true multidisciplinary care for the patient, with the patient, and centered around the patient.
Radiologists typically sit in dark rooms looking through hundreds of images a day. They work hard to ensure that they provide the best answers to some of the most challenging puzzles that patients bring to their physicians.
Radiologists have the ability to take all of the clinical clues given to them from other physicians on the care team, the power to look into the body and see images, and then put all of the information together to create a story for each patient.
The story about a disease, the location, the size, the physiology, and at times the ability to biopsy, to remove, and to treat a patients condition.
Radiologists seldom get an opportunity to articulate that story back to patients. I think they should be part of the conversation. A radiologist can help to explain information to patients through pictures. Patients do not care about the medical jargon, let alone the fancy words for this diagnosis or that one. Most will forget half of what you said once they leave your office. However, we all understand pictures.
A picture is worth a thousand words. I believe in healthcare that a picture is worth even more than that to a patient and their family. A picture is worth their time, anxiety, fear, and life. To have it explained why it needs to happen, what will happen, and then the results of what was found, and to do it with the assistance of images/pictures….that is a story patients will value and remember.
Radiologists are healthcare’s version of data visualization specialists. They have the power to see within the body.
In my opinion, it is time for radiologists to step out of the dark, and step into the light. To make your voices heard. To be part of the dialogue with the care team, but more importantly, with the patients seeking care.
In fact, you may have one of the most important jobs in healthcare, you get to tell the story of each patient through the universal language of pictures and images.
Will you tell your own story?
As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM
~CancerGeek