In response to a November 24 New York Times article, Dr. Strong submitted the following letter. It outlines his position on radiology’s ability to provide overall patient care and why radiologists are best equipped to be the doctor’s doctor rather than a patient’s.
To the Editor:
As a radiologist who has also worked as an ED physician (residency in internal medicine at Dartmouth-Hitchcock Medical Center with a subsequent radiology residency and a fellowship in musculoskeletal MRI at the University of Arizona, Arizona Health Sciences Center in Tucson), I have first-hand, hands on knowledge of both sides of the issues raised in Gina Kolata’s recent article, “Radiologists Are Reducing the Pain of Uncertainty,” (Nov. 24, 2014).
As a radiologist, I experienced the consequences of trying to get more involved in clinical decision making and patient interaction. Because of my prior training in internal medicine, I made great efforts to bridge the specialties by talking to patients, reviewing histories and lab values, and presenting a diagnosis with associated treatment recommendations. Despite my best intentions, my interactions confused patients and irritated referring clinicians to no end; had it continued, I would have been universally despised and unable to provide effective and credible care.
The radiologist and the referring physician are separate for a reason: there is simply not enough time in the world to do both jobs well. Most important, though, radiologists simply don’t have all of the information required to help treat and care for a referred patient, as aptly pointed out by Dr. Beaulieu.
Radiologists can’t answer – and shouldn’t answer – the “Now What” question patients undoubtedly ask. Patients should only speak with radiologists once they understand and accept that the radiologist has expertise in interpreting the image only – not in what course of care patients should or can pursue. The scan is a snapshot, a mile marker on a roadmap of the patient’s overall course of care. It is a diagnostic tool – albeit a critical one – but not an end in and of itself (contrary to what some patients think) used by the patient’s physician, not the patient.
Imparting clinical diagnoses and making treatment recommendations are best left to physicians who have access to a patient’s entire medical record and history. These doctors also have a relationship with the patient, know their mindset and understand how they like to receive information. They are current on the most effective therapies and procedures to treat a patient’s specific condition based on objective information a radiologist provides, as well as other clinical information. And, they can speak with the patient face-to-face in the privacy of a hospital or office environment; the radiologist interpreting the patient’s images are most often geographically separated from the facility in which the images were acquired.
Based on experience, I also believe that having one point of contact for a patient is the best way to achieve superior patient-focused care. The likelihood of a radiologist making an erroneous statement that directly conflicts with a previous statement made by a referring clinician increases with every word uttered to the patient by the radiologist. That’s not a recipe for “reducing pain,” but rather for increasing anxiety – and legal actions.
I accept that the ACR and RSNA would like to work to make radiologists more accessible to patients; however, they cannot forget this basic tenant: Radiologists are known as – and trained to be — the “doctor’s doctor” for good reason and must remain in that role.
If the ACR and RSNA forget this, their initiatives are doomed to fail and will only create more uncertainty, stress and confusion for patients.
Benjamin W. Strong, MD (ABR, ABIM) Chief Medical Officer, vRad