A recent article in Health Imaging discusses a study that caught my eye. According to the study, the article noted, 80 to 90 percent of radiologists remain “invisible to their patients and approximately half of the public is unaware of whether radiologists are physicians or technicians.” In effect, the “commoditization of radiology is becoming a pressing concern to many practitioners.”
The authors of this study provide a good solution: “By offering an even higher level of personalized service through direct communication, radiologists can dispel this viewpoint by showing patients that they customize imaging examinations to fit each patient’s individual healthcare needs.”
I find this relates to my own experiences as a radiologist and, in a way, to the low dose movement. One way to lower the dose of CT is to not do inappropriate CT scans. How do you decide what is inappropriate?
This is where the radiologist (a physician) as a knowledgeable advisor (who consults with other physicians about imaging) comes in.
Face time with patients can help them understand this role. It can also help them understand that lower dose in their appropriate CT exams is possible without compromising the diagnostic power of the exam – again, achieved through a knowledgeable radiologist designing the CT exam and monitoring the conduct of executing the exam.
A recent study I came across found that patients in emergency departments have very high confidence in CT scans and technology. Furthermore, it seems as if patients get increasingly more confident that they’ll get a proper diagnosis the more testing they have done. But compounding this is another finding of the study: most patients’ understanding of radiation exposure is poor.
The key to this discussion is the concept of appropriateness. What that means is the balance between cost, risk, and the chance that a test may provide valuable information, which impacts on therapy, outcome of the disease process, or peace of mind (which has value, too).
As this study points out, patients have confidence in CT, but that confidence does not translate directly to appropriateness. Risk of CT radiation is hotly debated, but that too does not equate with appropriateness by itself. And cost effectiveness is just one component of the stew that is appropriateness.
So, given all those limitations, how do we get there? Answer: use the radiologist – equipped with powerful support tools – as a consultant to find the balance that optimizes appropriateness. The radiologist is an epicenter of knowledge about radiation risk, cost effectiveness, and the potential positive impact of a CT. Add to that support from a decision support program – which is a compilation of all knowledge in these areas – and you have the best path to appropriateness in this complex world of high-tech imaging.