Houston, We’ve Had a Communication Problem in Radiology

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While reading the morning newspapers on Monday, I cringed when I came across a reference to a radiologist in an Op-Ed in the Wall Street Journal. It was written by an internist who was rejoicing the potential dismantling of Obamacare, and one of his patients, a smoker, had an irregular chest x-ray.

After jumping through insurance hoops to get approval for a chest CT, none of the imaging centers the internist typically used would accept the patient’s exchange-purchased insurance. The internist finally found a center that would take the insurance, and the patient had returned for the results.

The patient had a benign-appearing nodule and the radiologist suggested follow-up in six months, greatly disturbing the patient. “I suspected the radiologist might be over-interpreting the scan, but it was difficult for me to reassure the patient,” wrote Marc Siegel, MD. “I suggested he see a pulmonologist but then couldn’t readily find one who accepted his insurance policy. These difficulties are typical for Obamacare.”

I made note of Dr. Siegel’s name, because it also is impossible to find an internist in some parts of New York City who will take Medicare insurance.  A relative was in New York for an extended stay last year, and couldn’t find an internist on the entire island of Manhattan who would take a new Medicare patient unwilling to self-pay.

The Problem

That is, though, beside the point. I am not arguing the merits of Siegel’s case for dismantling Obamacare, I am pointing out, again, that radiologists have a communication problem. As this anecdote illustrates, the problem does not begin and end with the radiologist, but it does begin with the radiologist.

First of all, there is a trust problem, exacerbated by the fact that the internist was receiving a report from an unknown radiologist.

Secondly, there is a continuing reluctance on the part of radiologists to take ownership of their results—and perhaps an assumption that referrers know more than they do about the evidence on which radiologists make their recommendations.

Finally, there is a reputation problem emerging. (More on that in a minute.)

Multiple presenters at last week’s RSNA addressed pieces of radiology’s communication problem, and I plan to report on their ideas and experiences in future newsletters—improved language and structure in reports; higher levels of subspecialization; and surveying referring physicians and patients to understand what they want and need from the radiologist. All of these action items have moved to radiology’s front burners.

In his President’s Address, outgoing RSNA president Richard Baron, MD, made a persuasive argument for reviving the radiologist as Renaissance physician. While it may be the primary product of the radiologist, the report cannot be the only form of radiologist communication.

In her Annual Oration in Diagnostic Radiology, Vivian Lee, MD, suggested to the radiologists in the audience that they type “Radiologists are,” into the Google search bar, and see what search terms auto-populate.  It is not a pretty picture, but it should be enough to get you thinking about how to restore the reputation of the radiologist.

Better communication is a great place to begin.

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