Radiologist and Patients: The Full Continuum of Care
Radiologists participate in the full continuum of care for patients and thus have the opportunity to improve every phase of patient care.
The December 2016 JACR Special Issue on Patient- and Family-Centered Care provides a rich series of articles on how radiology is incorporating patients into the radiology value stream. Patients are increasingly involved in every phase of research studies; quality-of-care process improvement projects more often include patients as part of the team; the use of technology in patient portals is providing better patient access to records; and social media is improving communication between patients and radiologists.
These are examples of a proactive effort on the part of the ACR, through its Patient- and Family-Centered Care Commission (PFCC) to "help radiologists understand and improve the patient experience." ) The Commission's goals are to "produce resources to help radiology professionals provide and document patient- and family-centered care." This JACR special issue is one of the projects along the journey toward having every radiology professional understand the importance of providing patient- and family-centered care and their role in incorporating it into their practices.
What I find striking about this special collection of PFCC articles is that, although radiologists don't often interact face-to-face with patients; radiology, more than any other medical specialty, is an integral part of the full continuum of patient care, particularly cancer care.
An example of the continuum of radiologist (and radiation oncologist) care is in cancer care, such as with lung cancer. The continuum includes screening for early detection of lung cancer using low dose CT (LDCT) scans. Imaging is also used for diagnosis. PET/CT scans can help indicate if a pulmonary nodule found on an LDCT scan is likely to be cancer before proceeding to biopsy. PET/CT can also help determine if the cancer has spread outside of the lungs. Imaging is used to assess if tumors are responding to treatment. Imaging is also used to guide procedures, such as CT-guided biopsies and navigation during surgery. Radiation is used in the treatment of lung cancer, both with curative as well as palliative intent. And following treatment, imaging is used for continued surveillance for a possible recurrence of the cancer.
As part of my late husband Dan's lung cancer journey, we became familiar with all of these modalities. Dan underwent CT scans, PET scans, brain MRIs, CT-guided biopsies, as well as radiation treatments. I have avidly looked at every one of my husband's images and read every one of the radiologist reports, often having to Google the medical terms and watch YouTube videos on how to interpret the images.
Yet, despite my deep interest and perusal of these imaging study results, I have yet to talk to a radiologist who signed any of these reports. Up until very recently, I never really thought about radiologists as being part of my medical team. I've read all of my own radiology reports, but these were presented to me by other physicians: primary care, gynecologist, endocrinologist, orthopedic surgeon, and so on. In other words, everyone other than the radiologist.
Is direct patient and radiologist interaction the next step in improved patient care? Would it be helpful for patients to talk directly to a radiologist? I think would be worthwhile to find out. Perhaps a study observing the perceptions of randomized imaging patients who are directed to a radiologist at the time of service, or offered a follow-up telehealth radiologist consultation to discuss their results, as compared to the current standard of care, would help identify some of the benefits and challenges of direct radiologist patient interactions.
A radiology consulting clinic, already underway at Massachusetts General Hospital, may also provide insight into the possible benefits resulting from patients meeting with radiologists. The benefits to date include increased knowledge, patient activation, and motivation for behavior change.
I'm looking forward to working with the JACR and ACR in finding the best approaches to interactions between patients and radiology professionals on the journey toward improved patient- and family-centered care.