JACR: Direct communication with patients presents golden opportunity

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As patient access to imaging data increases with the adoption of online patient portals, direct communication of study results to patients could provide an opportunity to improve patient satisfaction and reassert the importance of the physician-patient relationship in radiology, according to an article published in the December issue of the Journal of the American College of Radiology.

Direct patient access to images presents a variety of new ethical and legal issues. Consequently, Nabile Safdar, MD, of the Sheikh Zayed Institute for Pediatric Surgical Innovation in Washington, D.C., and colleagues explored the issue of report ownership. While providers are considered the owners of the actual physical records, modern electronic communication and hosted services are clouding the definition of ownership.

Rather than focusing on ownership, the authors suggested thinking of medical records in terms of rights and responsibilities. Providers have the responsibility to maintain the integrity and privacy of records, and the right to keep the records as business documentation or for future research. Patients, on the other hand, have the right to view and have copies of their records.

“Both patients and healthcare providers are stakeholders with legitimate rights and interests related to the data in medical records,” wrote the authors. “In this sense, they could be considered co-owners of these data who are dependent on each other for their maintenance and appropriate use.”

While patient portals are a new phenomenon, direct communication of radiologic results to patients is not. Women’s imagers, pediatric radiologists, sonologists, fluoroscopists, fetal imagers and interventional radiologists have routinely communicated with patients, noted the authors, and that face-to-face contact serves to strengthen the physician-patient relationship.

“Patients value receiving their written or verbal results directly from radiologists while they are present at an imaging facility, even if the results are considered preliminary,” wrote Safdar et al. “Studies indicate that women want radiologists to directly inform them of their mammographic results, whether normal or abnormal, while they are still on site and that this practice increases satisfaction with the overall imaging experience.”

Concern for the attitudes of the referring physician is often cited as the reason for radiologists to avoid direct communication of results to patients, and there are certainly cases where results are best communicated to the patient through the referring physician, but this is not always the case, according to the authors.

“Referring physicians seem to be most receptive to such conversations when they have working relationships with the radiologists, seeing them as part of a healthcare team focused on the well-being of the patient, and when radiologists acknowledge the limitations of their role honestly when speaking with patients.”

Some radiologists may not want to relay results to patients or families who are under stress and fearful. While it may be easier to pass off the duty of patient communication, there are cases where the ethical choice is direct communication, and instruction on identifying and handling these situations should be included in the training of future imaging specialists, according to the authors.

As the ubiquity of internet access and online communication is transforming the way people access data in other industries, physicians should expect that transformation to continue in the realm of radiology. The inability to access images easily online poses a customer service problem, and if radiologists take a more active role in communication with patients, it may raise practice visibility, concluded the authors.