Monday, March 29, 2010

Comfort Zone

One thing I've run across lately are a lot of radiology reports that seem to make statements or recommendations that are a little, well, off. First, let me make clear - my field is radiation oncology, NOT radiology. Another thing that I have to make clear is that in most cases, the radiologist that looks at images from a CT scan, MRI, ultrasound (etc.) never meets the patient, and often doesn't know their clinical history.

So why is it that I often read in radiology reports things like, "fibrosis and scarring consistent with radiation-induced pneumonitis"??? Sometimes the patient hasn't even had radiation! Moreover, pneumonitis is a clinical diagnosis, not just a radiologic one. In a day and age when patients can access their own results, including radiology reports (which I am in favor of), this can be very dangerous to claim. And sometimes downright wrong.

Another thing that happens is that in the report, it reads something like, "5 mm area of enhancement not clearly imaged by CT. Recommend follow-up with CT in 6 months," or "Recommend additional MRI study." I find that it's interesting they can recommend this without even knowing the clinical situation. For example, what if the patient had some clinical condition that easily explained the imaging abnormality, but now because of this report, it's almost necessary to order this additional (and sometimes costly) test. If the reports said something like, "based on clinical scenario and judgment of the ordering physician, a follow-up CT scan may be indicated," I think everyone would be much happier.

Just to give an example - I certainly do not tell a cardiologist how to prescribe or dose anti-hypertensive medications. I expect other specialties to respect the same boundaries.

18 comments:

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Should Fish More said...

I don't expect it's like interpreting pulmonary function tests...the pulmonologist usually has not seen the patient, but a decent test will have a dx, some hx, such as smoking, rad or chemo tx, meds such as amiodarone, etc. That lets the pulmonologist make statements such as 'IPF, consistent with sarcoidosis'

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Here in Brazil following a recommendation (almost a law!): Only the doctor and nobody else can interpret the clinical examinations, diagnosis and precrever give the best treatment. Neither nurses, pharmacists, biochemists, rediologistas, laboratorians can do the job of a doctor. I think this recommendation applies to any country. Wilson. http://the-snakers.blogspot.com.br

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