Radiologists working to become more accessible to patients

When Dr. Jennifer Kemp's husband got advanced rectal cancer, she got an unexpected patient's-eye view of her profession.

Her husband was having scans every three months, terrified each time that they might reveal bad news. Kemp, a Denver radiologist, would sit down with her husband's radiologist afterward. Even so, it could be an hour before a scan was ready to be viewed.

"I couldn't believe how anxiety-provoking it was to wait even an hour," she said. "Sometimes he would get a scan I didn't feel comfortable interpreting and he had to spend 24 hours waiting — and I had connections. That was absolute torture." What must other patients go through, she wondered. Is there any reason that results are a private communication between a radiologist and referring physician? Is there any reason that patients end up waiting days, sometimes weeks, for their doctors to reveal what scans showed? Could radiologists actually talk to patients and give them results immediately?

It seemed to be a problem that could be solved, Kemp said.

She now heads a committee of the Radiological Society of North America that strives to make radiologists more accessible to patients, including by giving test results right away if asked, by either meeting with patients or talking to them on the phone. Kemp does that and gives all her patients and their doctors her direct telephone number.

The American College of Radiology has a similar initiative. The groups say the time is right — patients are more and more insistent on knowing how and why doctors make decisions about their care. And more and more medical centers and doctors' offices are allowing patients to log on and see their medical records, which can include reports on scans.

Neither group is advocating laws requiring radiologists to tell patients their results. Instead they hope to make their case by demonstrating how some radiologists have successfully managed to communicate with patients and by letting radiologists know this is something patients want.

But many people never consider asking to speak to a radiologist and many doctors seem to have no relationships with radiologists. And some radiologists say talking directly to patients is anathema. A radiologist, despite an M.D. degree, can't answer questions about drugs or surgery and without knowing the clinical history may not know if abnormalities are important. And would doctors even refer patients to a radiologist who blurts out a scan's results?

For now — with one big exception — how quickly a patient gets the results of a scan — including MRIs, PETs, CTs or ultrasounds — can be idiosyncratic and depend on the particular doctor and the particular patient.

Yet patients want to hear from radiologists, the groups say.

The exception is mammograms, where most radiologists meet with women immediately after their scan and those who don't send women their report. They have to, notes McGinty, herself a mammographer. The Mammography Quality Standards Act of 1992 requires that women get their results from a radiologist and says that if the scan indicates a woman needs a biopsy, the radiologist has to have a face-to-face conversation with her.

But despite the efforts of the two radiology groups, many radiologists remain sequestered in dark rooms, reading scans, sending reports to doctors within 24 hours, and letting the referring doctors decide how and when to talk to patients.

Dr. Christopher Beaulieu, chief of musculoskeletal imaging at Stanford University, says patients hardly ever ask to see their scans or talk to him or his colleagues. And, he said, on the rare occasions when they do ask, "there is pushback" from radiologists and referring physicians.

Changing the system, McGinty says, requires a culture shift. It starts, she says, with radiologists getting to know referring doctors. She has done that and she says her referring doctors "are comfortable with me speaking to the patients because they know who I am."