Diana Miglioretti, PhD, standing next to a CT scanner. Photo credit: UC Davis Health System, Sacramento, CA.
A few years ago, I watched a relative poring over her father’s chest x-ray report hanging on every word. He was 89. Everything sounded scary and worthy of worry. It’s bad enough when patients go for these tests, the machines alone are huge and enveloping. So you are almost set up to worry as soon as you have the study done.
There’s plenty wrong with radiology reports that can push you to fear the worst. According to Dushyant V. Sahanyi, MD, associate professor of radiology at Harvard Medical School, in fact, patients are scared far more than they should be in many cases. Dr. Sahani told Patient POV about a high proportion of patients coming to him for a second opinion who thought they had terminal diseases, based on their initial radiology reports. It turned out that all but one had findings of no consequence to their health. Dr. Sahani said:
“These patients thought that they were going to die because the language used in the reports was so frightening. When I reviewed and discussed their reports with them, many started to cry because they said that they never expected to hear such good news.” – Dushanyi V. Sahani, MD, Director of CT Imaging, and radiologist in the Division of Abdominal Imaging and Intervention at Massachusetts General Hospital in Boston.
Radiology Reports Use Misleading Language
One problem is that radiology reports are filled with annotations that are loaded and inconsequential to patients’ health and wellbeing. Reports flag all sorts of things that are nothing more than:
- Misleading medical jargon;
- A part of the normal aging process;
- Incidental findings that mean nothing is wrong;
- Benign findings –(having little or no detrimental effect);
- Indeterminate lesions.
The terminology varies from radiology department to department, explained Dr. Sahani, but going forward, “radiologists need to work at more clear communication in these reports.” It’s not just patients that are baffled by the reports; sometimes referring physicians can’t make heads or tails of them or they don’t address the precise reason why the doctor ordered the study or amplify the most clinically significant findings. Instead, the important findings are buried in the reports.
Introducing Reform
Dr. Sahani and many other radiologists are working on changing the way reports are written. The benefits are clear: patients won’t be unnecessarily scared to death a lot of the time and won’t begin a cascade of unnecessary consults and more tests. Referring doctors would also benefit: they could get information they need that is not mired in radiology lingo of no consequence.
Some ideas that Dr. Sahani and other radiologists suggest include:
- Putting the most important finding clinically at the top of the report in plain English.
- If there is something urgent in the report –even not having anything to do with why the doctor ordered it—put it at the front of the report.
- Stop inserting excess information that is not clinically relevant. That runs the gamut of amplifying findings related to aging, including repetitious ways of describing the same finding, or factoids only of interest for a radiology textbook.
- If additional imaging could help uncover what is wrong, specify why so that the referring doctor can explain it to the patient. Without it, it looks like the radiologist is looking to do an unnecessary procedure.
- If something is especially complex, radiologists should call or email the referring physician.
- Radiologists should also consider leaving a contact number for further questions.
There’s a silver lining in radiologists opening up about misleading radiology reports. Radiologists like Dr. Sahani and many others across the country are spearheading campaigns for more standardized radiology reports and more clear communication. It may be difficult to achieve consensus on what belongs in a report or what should be excluded, but it’s a good first step.
Pathologizing Not Unique to Radiology
Meanwhile, patients reading radiology reports should recognize that the reports may not be as alarming as they might seem on first glance. We are a long ways away from not pathologizing every finding in medicine. Patients need to maintain a high level of skepticism.
The same is often true for reading urine and blood results. Something may be outside the boundaries of “normal” or the “reference range,” but for a specific patient, it may be of little consequence.