Lab Soft News: Should Radiologists (and Pathologists) Communicate Directly with Patients?

Periodically I come upon discussions about whether pathologists should serve as "direct consultants" to patients as opposed to the normal indirect model. The latter, the norm, occurs when pathology and lab reports are sent to the test-ordering clinician who then communicates with the patient. I was therefore interested when I came across an article suggesting that radiologists perhaps should communicate directly with patients (see: Radiologists Are Reducing the Pain of Uncertainty). Below is an excerpt from the article:

Is there any reason that results are a private communication between a radiologist and referring physician? Is there any reason that patients end up waiting days, sometimes weeks, for their doctors to reveal what scans showed? Could radiologists actually talk to patients and give them results immediately?....[Committees convened by the RSNA] say the time is right — patients are more and more insistent on knowing how and why doctors make decisions about their care. And more and more medical centers and doctors’ offices are allowing patients to log on and see their medical records, which can include reports on scans. Neither [committee] is advocating laws requiring radiologists to tell patients their results. Instead they hope to make their case by demonstrating how some radiologists have successfully managed to communicate with patients and by letting radiologists know this is something patients want....But many people never consider asking to speak to a radiologist and many doctors seem to have no relationships with radiologists — they just hand patients [an order] for a scan and let them get it wherever they want. So change might take some doing. And some radiologists say talking directly to patients is anathema. A radiologist, despite an M.D. degree, cannot answer questions about drugs or surgery and without knowing the clinical history may not know if abnormalities are important. And would doctors even refer patients to a radiologist who blurts out a scan’s results? For now,...how quickly a patient gets the results of a scan, including M.R.I.s, PETs, CTs or ultrasounds, can be idiosyncratic and depend on the particular doctor and the particular patient.Yet patients want to hear from radiologists....[M]any radiologists remain sequestered in dark rooms, reading scans, sending reports to doctors within 24 hours, and letting the referring doctors decide how and when to talk to patients....[O]n the rare occasions when [patients ask to speak with radiologists], there is pushback from radiologists and referring physicians. Radiologists just do not have time to meet with many patients... [and] worry ...what happens when the news is bad.

I found one of the key points of this article somewhat odd. One of the arguments in favor of direct communication between radiologists and patients is that this would allow patients to receive imaging results faster. Note that the title includes a reference to "reducing the pain of uncertainty." Given today's electronic records, as soon as a radiologist completes and releases a report, it is immediately available to the clinician who ordered the study. The same applies to a report of a biopsy from a pathologist. The speed at which a patient is notified about the results is all about clinician priorities and goals. The author of this article apparently came to the same conclusion when she stated that it is up to the referring physician to "decide how and when to talk to the patient."

So, at least in my mind, the major advantage that a patient would gain by talking directly to a radiologist or pathologist about a report would be acquiring knowledge that these diagnosticians uniquely possess. In the case of the radiologist and discussing a lesion in the lung, this would boil down to a discussion of the differential diagnosis of masses in lung images. In the case of the pathologist, it would be perhaps a discussion of the pathobiology of lung tumors and what a malignant versus a benign lesion would look like under the microscope. I think that an occasional patient would benefit from such a discussion but probably not the majority.

I was referring above mainly to a surgical pathologist. I think that perhaps a more extended and useful discussion could occur between a patient undergoing a prolonged workup for a rare or obscure disease and a clinical pathologist who was well versed in, say, molecular pathology or cancer genomics. In such a case, a direct conversation could be very helpful for an engaged patient.