Point A to Point B
Sometimes communication between radiologists and their referring physicians is not exactly straightforward. In fact, seemingly easy concepts can become unnecessarily complicated.
When radiologists draft reports, naturally they provide information about the abnormality for which the imaging was ordered as well as any incidental findings.
But as they compose and send reports to busy specialists and primary care physicians — not to mention patients in some cases — radiologists must consider more than communicating their findings. They must also give some thought to the words they use and the way they present their findings to ensure that their reports are valuable and readily understood by those down the line. While radiologists generally meet these objectives, as with most things, there is always room for improvement.
Dushyant V. Sahani, MD, associate professor of radiology at Harvard Medical School, radiologist in the Division of Abdominal Imaging and Intervention at Massachusetts General Hospital in Boston (MGH), and the director of CT imaging at MGH, knows firsthand what can happen when radiology reports fail to convey their findings clearly. Sahani recently provided second opinions to several patients who thought they had terminal diseases based on their initial radiology reports. But when Sahani reviewed the patients' images and reports, he found that all except one actually had innocuous findings. "The language that was used in the reports was so scary that these patients thought they were going to die," Sahani says. "And when I gave them a consultation, a lot of them started crying and said that they had never heard such good news."
The experience led Sahani and other MGH radiologists, including Andrew J. Gunn, MD, a radiology resident, to discuss what they should include in their reports. "There were different opinions amongst radiologists about the things that we should say in our radiology reports," Gunn says. "But my thought was that the radiology report is not generated for other radiologists; we generate the report for the referring doctors." Gunn, Sahani, and two other MGH physicians then conducted a survey, asking the hospital's referring physicians what they want in radiology reports. As it turns out, referring physicians also have varied and sometimes contradictory opinions about what can be done to improve radiology reporting. But it seems everyone who weighs in on the matter can agree on one thing: clear communication is a must.
What Referring Docs Want
Of course referring physicians expect radiology reports to be accurate and timely, but they also want reports that consciously address their questions. "We rely on our radiology colleagues and their review of the images to really help us in making diagnostic and treatment decisions," says Neesha N. Choma, MD, MPH, assistant chief of staff, executive medical director for quality and patient safety, and assistant professor of medicine at Vanderbilt University Hospital in Nashville, Tenn. "The sooner we know what they found out, the quicker it allows us to act upon it and provide the care that we need to provide."
Referring physicians say radiologists can improve their reports by avoiding jargon, refraining from using different terms to describe a single ailment, and limiting the inclusion of ancillary information. "Sometimes radiologists will use radiology-specific terminology or descriptors or they'll use the names of the people who first discovered the condition, and I have no idea what that means or what the clinical implications are," says Francis X. O'Brien, MD, assistant professor of medicine at Wake Forest Baptist Health in Winston-Salem, N.C. Once radiologists have the information narrowed, referring physicians say they should include all consequential findings in the report's impression, ordered from most important to least. "If there's something sitting in the body of the report that we really need to know, even if it's not related to the reason we got the study, that should be put within the impression," Choma says. "And if it's anything of high value, they should try to put it as close to the top as possible in the impression."
Referring physicians also say that radiologists should provide supporting information when recommending additional imaging. Without it, referring physicians sometimes wonder whether additional studies are really necessary. "They always finish the radiology report with, 'I think the patient needs another radiology study,'" says Wakenda K. Tyler, MD, MPH, assistant professor of orthopedic surgery at the University of Rochester Medical Center in Rochester, N.Y. "And it looks like they're lining their pockets a little bit. I don't think that's what they're really doing, but you hear a lot of doctors who are not radiologists complain that that's what it looks like." Moreover, the supporting information helps referring physicians explain the need for additional imaging to patients. "We actually rely on the radiologists to help us with that," O'Brien says. "They should provide the data or the reasoning as to why we should pursue additional imaging, which will take time and expense on the patient's part."
Open Lines of Communication
Although they don't have time to search for pertinent details hidden within reports, referring physicians agree that they are never too busy to take a call, e-mail, or page from a radiologist with a critical or complex finding. "Additional communication to notify about anything that is outside the norm is always appreciated," Choma says. "There's no one who would not appreciate getting an FYI phone call about something. Again, there are time limitations....But the gold standard is always to have more communication rather than less."
Some radiologists go so far as to include their contact information in their reports, which referring physicians say they appreciate because it indicates that the radiologist is available for questions. "At the end of the report, if it said something like, 'Please call my office number if you have any questions about this report,' boy, it would make my life easier," Tyler says. "I can't tell you how many times I've had questions about reports, and I can't even figure out which radiologist read it or where they read it from." The gesture can encourage communication and help build relationships between radiologists and referring physicians. Established lines of communication are key for radiologists who want feedback about their reports, as many referring physicians don't have time for surveys. "I have so many other people who want feedback, if the radiologist starts calling on me to fill out forms about by satisfaction, I'm going to throw that right in the trash," O'Brien says.
Radiologists don't have to do everything that referring physicians want, but they should be open to their suggestions, says Mark J. Adams, MD, FACR, professor and associate chair of imaging sciences at the University of Rochester Medical Center in Rochester, N.Y. "Our main service is to the patient, but another one of our customers is our referring physicians, and if they want it a certain way, we'll do our best to provide that for them," Adams says. Sahani agrees and says that radiologists are obligated to meet referring physicians' needs to ensure patients receive the best care possible. "As radiologists, we are as good as our reports," he says. "It doesn't matter how many awards we have won and what great contribution we are making; if our reports aren't clear, they are not very helpful to the referring physician or to the patient."
By Jenny Jones