Who should break the news? Communication of examination results to patients and primary care physicians

1. Who should break the news? Communication
of examination results to patients and primary
care physicians
Andrew J. Gunn, MD
Dushyant V. Sahani, MD
Susan E. Bennett, MD
Garry Choy, MD

2. Financial Disclosure
The authors have no relevant financial disclosures that
would pose a conflict of interest with this study

3. Additional Disclosure
You are about to hear a lot of opinions!

4. Introduction
• The radiology report is the principal method by which the radiologist
communicates the results of an examination to the referring physician and the
patient
• There is considerable interest in improving radiology reporting practices
– “Patient gateways” are becoming more common
– Raises questions about the language used in reports
• It has also been suggested that radiologists should be more pro-active in
delivering the results of examinations directly to patients

5. Questions
• How do referring physicians perceive the language we use in our
reports currently?
• How do referring physicians feel about the practice of radiologists
delivering examination results directly to patients?
• Should radiologists adjust the language in reports based upon the
specialty of the ordering provider or because of increased patient
access to reports?

6. Materials and Methods
An on-line survey was distributed to 229 primary care
physicians at our institution through an internal listserv

7. Results
• Respondents
– 100 responses (43.6% response rate)
– Averaged 19.1 years in practice (range: 2-50 years)
– 95% order less than 20 examinations per week

8. Results
• Clarity of language used in radiology reports was excellent with a
mean score of 3.99
– Clarity of language rated the second most important component
of the radiology report (14% of respondents)
• Room for improvement in the language we use
– Unclear language cited as the “most significant problem with
reporting” by 19% of respondents

9. Results
How should a patient learn the results of an
examination?
95
No. of Responses
5
0
Ordering Physician Radiologist Access themselves
online

10. Results
Should the radiologist adjust their language based on
the specialty of the ordering provider?
80 70
No. of Responses
60
40
23
20
7
0
Yes No Unsure

11. Results
Should the radiologist adjust their language because of
increasing on-line access by patients?
50 43
No. of Responses
40 35
30
22
20
10
0
Yes No Unsure

12. Discussion
• Primary care physicians feel that clarity of language is an important
component of radiology reports
• Primary care physicians are generally pleased with the overall clarity of
language used in radiology reports
– Other problems with language such as typos, discrepancies in the
report, long reports, and short reports were cited by very few
primary care physicians
• Still room for improvement

13. Discussion
• No primary care physicians thought radiologists should be delivering results of exams
directly to patients
– Type of communication is still unspecified
– Type of interaction with the radiologist was not specified
– Only surveyed primary care physicians
• Runs against current trends in radiology
– Driven by a variety of factors
– Good for patients?

14. Discussion
• Why is there apprehension on the part of primary care physicians?
• Multi-factorial but several reasons have been suggested
– Loss of the patient relationship
– “Blind-sided” by results
– Radiologists may not know the entire clinical scenario
– Radiologists may not be prepared to answer all patient
questions

15. Discussion
• Few referring physicians thought that radiologists should adjust
their language based on the specialty of the ordering provider
• Plurality of primary care physicians felt that radiologists should
adjust their language now that patients have increased access to
their reports on-line
– More concern about what patients see in their reports

16. Summary
• The language used within the radiology report is important
• Primary care physicians prefer to deliver the results of
examinations themselves
• Radiologists should consult with their referring physicians before
undertaking any change in reporting practices

17. Selected References
1. Hall FM. Language of the radiology report: primer for residents and wayward
radiologists. AJR Am J Roentgenol 2000; 175:1239-42.
2. Paz D. The radiologist as a physician consultant. J Am Coll Radiol 2010;
7:664-6.
3. Safdar N, Shet N, Bulas D, Knight N. Handoffs between radiologists and
patients: threat or opportunity? J Am Coll Radiol 2011; 8:853-7.
4. Hammerman HJ. Communicating imaging results to patients: OnSite results.
AJR Am J Roentgenol 2009; 192:852-3.
5. Berlin L. Communicating findings of radiologic examinations: whither goest
the radiologist’s duty? AJR Am J Roentgenol 2002; 178:809-15.

18. Comments or questions?
Please feel free to contact me via email at agunn@partners.org