Many diagnostic radiologists today have little or no patient contact. How did this happen?
- The role of interventional radiologists
Whereas once, a general or diagnostic radiologist performed angiograms and various biopsies/drainages, these procedures are now often reserved for interventional radiologists in many practices. As a result, diagnostic radiologists less frequently see patients face to face.
- Procedures requiring patient contact are declining
Procedures that are still performed by general or diagnostic radiologists have been declining. Upper GIs, barium enemas, cystograms, and myelograms - which once broke the reading routine and created an avenue for patient contact - have been largely replaced with endoscopy and cross-sectional imaging.
- Increasing pressure for efficiency
The pressure to improve efficiency has resulted in radiology practices using “workplace extenders” to perform procedures that were once commonly performed by radiologists, such as starting IVs for CTs or placing PICC lines.
- Compensation linked to clinical reporting
Although the radiologist’s job description may include reading exams, supervising technologists, speaking with patients, selecting equipment, setting policies, and consulting with colleagues, compensation comes almost exclusively from generating a clinical report. Like most people, radiologists tend to do what they are paid to do.
- Teleradiology is here
Teleradiology, whether during the day or night, eliminates the opportunity to meet with patients in person. While video conferencing could bring the radiologist to the patient, I’m not aware of any imaging practice that has implemented video conferencing with patients.
- Many radiologists prefer less direct patient contact.
As a result of these technical changes, cultural shifts, and financial disincentives, it’s no wonder that the interaction between diagnostic radiologists and patients has declined. Is this trend a good thing, bad thing, or irrelevant?
I’m among the radiologists who believe that increasing patient contact is essential to the long-term success and happiness of radiologists and, ultimately, their patients.
What’s the basis for my reasoning? It’s Good Medicine.
Face Time Matters
Patients want to receive accurate information regarding imaging, and the radiologist is best equipped to provide it. While studies show various results, virtually every published study investigating how patients feel about direct interaction with radiologists has shown that a significant plurality, if not the majority of patients (and family members), value access to the imaging report and conversation about their imaging results with the specialist who interpreted the exam. Speaking with a patient creates a service event that is memorable and advantageous for all involved.
Direct patient contact, especially if combined with appropriately designed registration software and processes, also creates an opportunity for both the healthcare system and patient to better understand legitimate imaging screening needs. The Unity States Preventive Services Task Force (USPSTF) and other organizations now provide guidelines for imaging screening, including exams such as mammography, bone densitometry, CT lung cancer screening, abdominal aortic aneurysm ultrasound screening, and breast MRI. Other tests that have more controversial screening indications include CT coronary calcium scoring, CT colonography, and perhaps prostate imaging (ultrasound or MRI) in high risk patients. Today, compliance with each of these procedures is poor. We can improve population health by directly understanding each patient’s imaging screening needs and educating patients about those needs.
Better Communication. Better Choices.
Growing healthcare deductibles have resulted in patients spending more out of pocket dollars for imaging and other healthcare services than ever before. Some estimates indicate that U.S. consumers will spend as much as $400-500B out of pocket for healthcare this year. Simply stated, patients are now consumers and increasingly selecting their providers. Without any direct patient contact, imaging practices leave the consumer little reason to make intelligent choices about the imaging provider or whether imaging is preferred over other healthcare options. Therefore, although communicating with a patient may hurt reading efficiency in the short run, it pays off in the long run.
Physician Happiness and Recruitment
Radiology residencies, which were once one of the most sought after residency programs, are dropping in popularity for a variety of reasons. Medical students cite financial and social motivations for selecting their fields of residency. Among those who do not choose diagnostic radiology, the lack of patient contact is frequently cited as their motivation to pursue other specialties. Furthermore, burnout among radiologists is on the rise, in part because of the stress related to working on the image interpretation assembly line. Taking a break to speak with a patient provides a rewarding social interaction.
In short, physicians should strive to increase their patients’ levels of satisfaction, health literacy, and improve their understanding of screening needs. They should also reward themselves and their practices with some meaningful patient interaction and direct patient communication - every day.