To restate the obvious, surgical pathology reports have a new audience -- patients. Some of them are accessing their reports via patient portals (see, for example: Patients Often Lukewarm about Patient Portals; Problems with Training?; Could Apple Be Trying to Develop a "Patient Portal" for the iPhone?). Traditionally, pathologists have dictated these reports with the understanding that they were communicating primarily with the physicians who submitted the tissue for diagnosis. An important question these days is whether the language of these reports needs to be altered in any way now that patients are reading them. A recent article discussed a radiologist-developed "platform" that tweaks radiology reports so that they can be better understood by patients (see: New platform creates patient-friendly radiology reports). Below is an excerpt from it:
Patients may soon have a much easier time understanding the details of their own radiology reports, thanks to a platform presented by Seong Oh, MD....The platform, called Patient-Oriented ReporTER (PORTER), was designed as a response to the increasing prevalence of online patient portals and various online medical resources. Patients are being asked to access their own information from home, Oh and his colleagues recognized, but radiology reports are still being written as if they’ll only ever be read by someone with a medical background....PORTER takes the radiologist’s findings and helps translate it so that patients with no medical knowledge can fully understanding the information. Key words are underlined, and users can hover their cursor over those words to make the definition pop up. Click “axial,” for instance, and PORTER will say, “An anatomical plane that divides the body into head and feet portions.” Visual aids are also provided, including charts, graphics and a photograph of the radiologist completing the report....One of the biggest advantages to patients understanding their own radiology reports, Oh said, is that it empowers patients to ask the right questions when they meet with their referring physicians.....Oh said PORTER is still in the early stages, but a prototype has been fully developed to be used with knee MRI reports at Penn Medicine. In the near future, patients will be asked to use PORTER at home to review their own reports and then complete a detailed survey about their experience.
In a blog note posted almost two years ago, I presented some criteria that pathologists and radiologists could follow to make their reports clearer to other healthcare professionals (see: Avoiding Qualifiers, Exceptions, and Hedges in Radiology and Pathology Reports). I list them below:
- Speak to the referring clinician whenever there is ambiguity or extreme complexity of a case.
- In reports, avoid a vague rambling discourse as well as qualifiers, conditions, and exceptions.
- Whenever possible, arrive at a reasonable and actionable conclusion in the report to guide the clinician.
The major thrust of this current note is different from my previous note. The question is now being asked whether pathologists should seek to achieve greater clarity with their reports and also perhaps take steps to make them more understandable by patients. I have a feeling that the "PORTER platform" described in the excerpt above may be unacceptable for many radiologists because of the possibility that the software might malfunction and introduce mistakes or misunderstandings into a report when viewed by patients. So what action should be taken to make surgical pathology reports better understood by patients? Given that the primary audience for such reports will continue to be the physicians ordering them, I am not sure that an app like PORTER would be suitable. However, it might be appropriate on patient portals to post a glossary of medical terms used by pathologists and radiologists in their reports that could be used by patients to better understand their reports.
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