Toward the end of his presidential address to the annual meeting of the Radiological Society of North America, R. Nick Bryan, MD, PhD, exited his year-long term with a remark that will resonate for some time to come. “I strongly argue that it should become routine to provide our patients with their images,” he said. “I do not think it is practical [to speak with every patient] but I do think we should provide outpatients with their images. We should be a patient’s physician, not just a doctor’s doctor.”
As a consumer of health care in America, I said, right on, deputize me. Give me custodial care of my health. In light of the fact that medical errorwhich accounts for the deaths of between 44,000 and 98,000 hospitalized Americans1 each yearis being touted as the eighth leading cause of death in America, health care organizations could use the help. And at the rate that Americans move their residences and switch health plans, the likelihood of a functional electronic medical record that will follow a patient everywhere is near nil in the immediate future. If there is to be an electronic medical record with any totality on the horizon, clearly, it will be the one that is maintained by the patient. Why not help the patient compile it?
Certainly, there are public relations benefits to handing the patient a tangible record of their visit. Unless an intervention was performed, the patient will not leave the radiology department or the imaging center with an impression of any caregiver other than the technologist. Providing a record of the encounter also shows that the radiologist stands behind their technology and technique in this time of proliferating imaging equipment outside the radiology department. Perhaps radiologists should take their cue from OB-GYNs, who early on recognized the marketing magic behind handing off baby’s first picture. Is there any other imaging procedure that is so eagerly undertaken by the patient?
But there are medical reasons for distributing images as well. People with chronic conditions and those seeking second opinions are well advised to maintain copies of health records, including imaging. Some mammographers will not read a screening mammogram on a new patient without seeing a prior. This is not just good public relations, it is good medicine.
Some health care organizations are already accommodating patient requests by putting their images on a CD, and others, such as the University of WisconsinMadison Medical School (see story, page 25) are grappling with the mechanics of devising a system that will include a verifiable audit trail as per the Health Insurance Portability and Accountability Act. But beyond the mechanics of the hand-off, there are some additional questions that need to be answered.
1. Without the report, the images, theoretically, are useless to anyone but a radiologist. Should patients be advised to obtain the report from their referring physicians?
2. What of the potential political fallout? Will referring physicians resent the fact that patients have the images before they do? Should the image be withheld until the report is available?
3. What of the images generated by analog technology? Should they be digitized or should patients be charged for film copies?
Was this a watershed moment, or just a dramatic exit from an outgoing president who wanted to leave a memorable calling card? Time will tell. In the meantime, what are your thoughts on this subject?
- Kohn LT, Corrigan JM, Donaldson MS.