Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Patient Engagement One Radiologist at a Time

Radiology practices that don't allow direct patient engagement with the radiologist may become marginalized.

I had recent hip replacement surgery. The damage was a lot more extensive than anticipated. My acetabulum was worn through and the surgeon had to grind up my femoral head, do a bone graft, and cement the prosthesis liner into a cage that is screwed into my ilium. The cage has three flanges, two at the top and one at the bottom that is slotted into my ischium.

After the surgery (on the day of the operation), I developed pudendal neuralgia. My surgeon has not seen this in over 20 years of practice and thousands of hip replacements. We theorized that the pudendal nerve was stretched. Due to wear, my right leg was an inch shorter than my left leg, my left side compensated by misaligning my hips. The surgery restored my right leg length instantaneously, so it is possible everything is stretched. The alternate hypothesis is that the bottom flange on the cage is bothering the pudendal nerve.

Up until recently, my symptoms occurred mainly when I was sitting. I managed this by creating a special cushion (I am an engineer): a toilet seat on top of a donut pillow. In fact, some of you may have seen me walking around ACR 2017 with my cane and lugging my special cushion disguised with a jazzy pillowcase cover.

Unfortunately, my pain has recently gotten worse. Nowit's a sharp, stabbing pain akin to knives stabbing me in the genital area that occurs even when I am standing or walking. Understandably, this is distressing to me and I want to fix it.

I had a CT scan last week and the radiology report included a statement that said, "The inferior acetabular component extends through the pelvic wall into the pelvic soft tissues. There is an adjacent minimally displaced cortical fracture." I wanted to ask the radiologist a question about the uncertainty in CT imaging in assessing the location of the acetabular component in relation to my pudendal nerve. My question is, will it be possible to assess the extent of intrusion into the pelvic soft tissues to see if the flange is indeed anywhere close to the pudendal nerve?

Remembering all of the discussions around radiologists talking to patients at ACR 2017, I called my imaging site and asked to speak to the radiologist. The receptionist I talked to said that was not possible. She said I needed to talk to my referring doctor to discuss the results and my doctor could talk to the radiologist. I persisted and got transferred to another person who repeated the same message. I persisted again and got transferred to a manager. (Of note, I am a frequent flyer at this imaging facility so suspect I'm considered a good "customer.") The manager gave me the same message and continued by saying the radiologist did not know the clinical context so could not give me any information and that I needed to work through my doctor. I explained that I had a specific question about the imaging capability not about the clinical evaluation. To his credit, the manager then offered to ask the radiologist my question. Of course, the radiologist, not knowing the context, was unable to provide any information. If I'd had the opportunity to provide the context as part of a discussion, I may have gotten an answer.

I then tweeted about my experience. Within minutes Syed F. Zaidi, MD, vice president of clinical operations and growth at Radiology Partners (@zaidirad) offered to help me. I e-mailed him the context and my question and he provided me the information I needed. This experience went beyond any expectations I have for a patient-friendly experience with a radiologist. 

I realize there are concerns on the part of radiology practices about the logistics of having patients talk to radiologists, about the lack of ability to bill and about legal/liability exposure. Putting a note and a phone number at the bottom of the radiologist report for patients to call if they want to talk to the radiologist would be a good start. Tracking the number of calls and the value provided to patients through surveys and potentially improved adherence to follow-up recommendations may help change the payment model for this service. Given the concern over commoditization and the focus on patient-centered care, figuring out how to do this is a win-win for patients and radiologists.

Read More

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Thursday, 18 July 2019

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