Playing the Waiting Game
How Delays in Interpretation Affect Patient Emotions
Each day, radiology practices complete hundreds to thousands of studies. As residents, these demands gloom over us as an impending responsibility upon graduation from fellowship. As Friday 5:00 PM rolls around, often that voice in our head says, “This oncology workup can wait until Monday.” We may not consider the patient’s perspective. How do patients feel waiting each day their results are not available?
In this month’s JACR, a group from the University of Michigan investigated this issue. Survey forms were distributed to patients over a three-month time frame. About 200 patients consented and completed the study. Three prompts in the questionnaire focused on the emotional response associated with waiting for results.
The majority of participants were white women above the age of 50. Those who responded presented to the department for CT, MRI, or ultrasound. The primary outcome, time-to-result, was one to three days after scanning. Patients also conveyed calling their providers one to five days after scanning to obtain results, depending on the study and indication.
Questions probing the emotional impact of waiting composed the secondary outcome. Surprisingly, most test subjects reported no change in state of mind and no change in emotions when having to wait for results. If patients reported an emotional change, anxiety was the common response, and the severity was minimal to mild.
The team acknowledges flaws in the design such as limiting the study to outpatients immediately after scanning versus inpatients. Patient selection bias was addressed through patient advocates administering the survey as trained interviewers. However, there are inherent concerns. The sample size is low, and the study interval short. Additionally, the population skewed toward one demographic. Interestingly, the study occurred over the holiday season which may have some impact on the results. Patients may be more stressed about negative results or downplay the urgency to gather results altogether.
In looking at self-reported patient demographics, some key observations are illuminating. Of the patients who responded to medical history: 28% reported anxiety; 26% depression; 23% cancer; and many having prior imaging within the last year. Perhaps in future studies with a larger population, subgroup analysis of patients with mental illness could change the conclusions made in the paper.
Information in the 21st century is an on-demand service. Patients accustomed to the immediate availability of content, especially among younger generations, will rise in the coming decades. As our worklist volume grows, these demands to provide fast and accurate reads will not subside. In stark contrast to this trend, patients still prefer to receive their results personally by the referring provider or the interpreting radiologist rather than through impersonal online medical records. In the end, pour another cup of coffee, and consider reading that 5:00 PM study after the work bell rings.
By Michael Chorney, M.D.