Q&A | Patient Communication: Pandoras Box or Panacea?

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Leonard Berlin, MD
Richard N. Taxin, MD

Direct communication of imaging results by radiologists to patients has bubbled to the surface in the last few years. It’s fueled by patient demands for expediency, healthcare reform and the role of miscommunication in malpractice suits. Proposed, but stalled, legislation in Pennsylvania—the Patient Test Result Information Act—would have required radiology facilities to send exam results to patients.

Health Imaging & IT met with a pair of experts in this area to dissect the debate. Leonard Berlin, MD, is vice chair of radiology at NorthShore University Health System in Chicago, and a leading expert in legal issues in imaging. Richard N. Taxin, MD, is vice chair of radiology Crozer-Chester Medical Center in Upland, Pa., and is former president of The Pennsylvania Radiological Society, which opposed the legislation in Pennsylvania.

Q: What benefits might direct communication bring to the practice of radiology and to patients?

Berlin: Failure of radiologic communication plays a role in 80 percent of malpractice suits. Ensuring that patients have received imaging results can mitigate this issue.

The Mammography Quality Standards Act (MQSA) has required imaging providers to send women a copy of mammography results for 11 years. Although mammography is highly litigious, since MQSA, I have yet to see a suit filed because of a missed communication of breast cancer.

Direct communication also can elevate the profession. Currently, radiologists aren’t in the public eye; a lot of people do not know who a radiologist is or what he or she does. Direct communication ties into the American College of Radiology’s Face of Radiology campaign, which educates patients, payors, government officials and other healthcare providers on what radiologists do and why they are vital to providing the highest quality patient care.

Finally, there are real benefits to patients’ health, which, after all, is why we are here. Better public relations and better recognition are secondary to what is best for patients. Some aspects of imaging are beyond our control, but communication is within our control. There should be no excuse for failure of communication.

Q: Some radiologists and professional organizations have opposed legislating direct communication to patients. Can you encapsulate the argument?

Taxin: I have no problem personally giving results to patients and do so daily with breast imaging. But to make it mandatory for all types of exams is problematic.

A patient may not understand the results when they are included in a letter. A radiology report is not like a lab report. A lot of the information is technical and the patient’s understanding may be limited.

The primary care provider should usually be the one to discuss results with the patient. Consider a patient with known cancer, but no suspicion of metastatic disease, who presents for a follow-up CT. If the CT shows that the liver is filled with tumor, there is no way to explain this in a letter. It is impersonal. The conversation is best left to the primary care physician or oncologist.

Q: What are the key legal and operational considerations that departments and practices need to consider as they contemplate direct communication of findings to patients?

Berlin: There ought to be no controversy about this. When MQSA was passed, there was quite a hullaballoo among referring physicians and radiologists. The uproar died within two to three months. MQSA works well for referring physicians, patients and radiologists; every radiology facility has a mechanism to send the report or a summary of the report.

Taxin: There are cost constraints that could potentially make this a very expensive proposition. Just mailing the letters would have national costs that would reach hundreds of millions of dollars.  There are Health Insurance Portability and Accountability Act (HIPAA) implications. If a patient moved, someone else might open the letter, or the practice might not be able to locate the patient.
Direct communication is a nice idea, but the unintended consequences are indeed considerable.