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Michael Booker

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Q: How do you approach conversations about medical issues with family members?

A family member recently had a series of imaging studies performed and asked me to clarify a few findings in the report. Many were boilerplate for people their age (fat containing inguinal hernias, white matter hypertensive change, multilevel degenerative disc disease), but they generated apprehension and anxiety. I wish we, as radiologists, had a better way to communicate to patients when we think findings are normal — or at least fairly normal — the same way I was able to do with this individual. 

Given that patients have increasing access to medical records, does the fundamental approach to the radiology report need to change? On one hand, if I stopped mentioning benign findings, would my thoroughness be brought into question? Am I even provided enough patient history to make these determinations accurately? Standardized reporting encourages us to comment on the appearance of every organ, but it is much harder to omit minor findings when the alternative is asserting “unremarkable.” There is no easy answer, but we can save our patients some undue anxiety by better contextualizing findings within an expected normal range. Resources such as the Lumbar Imaging with Reporting of Epidemiology Protocol for degenerative lumbar spine changes and the Diagnostic Imaging 2018 – Quality Measures (developed by an ACR multidisciplinary technical expert panel) already provide roadmaps for just this purpose. And you may even save your family members from undue stress and anxiety.


Michael Booker, MD, MBA, is a radiology resident at the University of California, San Diego, and an ACR Moorefield Fellow.

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