RSNA: Dr. No-name not welcome in lung cancer screening model

CHICAGO—Several decades ago, it wasn’t uncommon for fledgling radiologists, pathologists and anesthesiologists to be advised that they could tell if they were doing a good job if patients did not know their name. The no-name practice model no longer suffices and is a disservice to radiologists and their patients, according to panelists during the RSNA opening session on Nov. 25.

Sheila Ross, special counsel, Lung Cancer Alliance, and Karen E. Arscott, DO, associate professor of clinical science at Commonwealth Medical College in Scranton, Pa., both have survived lung cancer. Both had strong messages for radiologists.

The Hippocratic oath revisited

Arscott underwent a routine follow-up CT scan in 2005. The curious physician/patient asked to see the images and immediately realized she had cancer. Her next contact with a physician arrived in the mail seven days later. A radiology report succinctly stated the presence of a malignancy and recommended clinical correlation.

Since her diagnosis, Arscott has undergone nearly 30 CT and PET studies. “I have never once spoken with a radiologist,” she said. In fact, during one CT study that was performed with an incorrect protocol, when Arscott asked to speak with the radiologist, the technologist told her that the radiologist would not talk to her.

Arscott experienced similar lack of empathy on the part of the radiologist who performed a CT-guided biopsy. She urged radiologists to practice two principles from the modern version of the Hippocratic oath:

  • I will remember that there is art to medicine as well as science, and warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
  • I will remember that I do not treat a fever chart or a cancerous growth but a sick human being whose illness may affect the person’s family and economic stability. My responsibility includes these related problems if I am to care for the sick.

Patients are vulnerable and want to talk with physicians, according to Arscott, who concluded with simple advice for radiologists: Meet your patient. Care for your patient.

Guidelines: The missing element

Ross has observed that paradigm of the anonymous radiologist is beginning to change. However, she believes the specialty has missed an opportunity for lung cancer advocacy and support by neglecting to develop screening guidelines and standards.

“We [patient advocates] have to join in common cause with radiologists,” Ross said. She noted a convergence of events—the success of the National Lung Screening Trial, publication of positive cost-benefit analyses, the spread of organized screening programs—that are pointing toward implementation of lung cancer screening programs.

“Our highest priority is to see that screening is implemented safely, equitably and efficiently,” Ross said.  “It’s confusing and disappointing that radiological societies have not issued guidelines on CT screening. It is critically important that radiologists develop standards and guidelines as a professional society. This cannot wait until 2014. Without radiologists’ help, those who are opposed to screening will have the upper hand.”