ACR Bulletin

Covering topics relevant to the practice of radiology

Report to the Patient

Provider understanding and patient empowerment hinge on how radiologists present findings.
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We want patients to become more involved in their own healthcare. We want them to understand their results and how to act on them.

—Hanna Zafar, MD
March 30, 2019

A radiologist’s report should be succinct, accurate, actionable, and easy for ordering providers and patients to understand. This is the message Hanna Zafar, MD, associate professor of radiology at the hospital of the University of Pennsylvania’s Perelman School of Medicine, sends to radiologists looking to move the needle on effective patient care.

With patient satisfaction tied to how clearly ordering physicians are able to relay information to patients — and what sense patients can make of their imaging results — radiologists should be moving away from meaningless jargon and antiquated formats. In a recent interview with the Bulletin, Zafar discussed creating reports that can lead to meaningful patient discussions and better healthcare outcomes.

What do you consider an ideal radiology report?
It’s a report that combines imaging findings, including pertinent negatives, with relevant patient history to answer clinical questions succinctly and clearly. It should be devoid of voice recognition and grammatical errors. Structured reporting can greatly assist in achieving these goals. The report should also include potential next steps, when warranted.

Why are you advocating for more patient-friendly reports?
My interest in improving communication with patients is a natural extension of my interest in improving communication with ordering providers. The radiology report is our product. Radiologists are, in many respects, inconsistent in how we create that product. We frequently include descriptive prose and terms that may be sensible to other radiologists, but do not make sense to providers and patients. It’s almost as if we write reports for one another. Our impressions are often lengthy, listing findings and technical descriptions (e.g., increased T1 signal) without a clear or preferred diagnosis — or guidance on possible next steps. We can do better.

How can radiologists improve the readability of reports?
Be clear, brief, and put your nickel down in the impression. While patient preferences vary, most patients want to access radiology reports and receive radiology results from their ordering provider. Given this, reports need to be short and written in plain language, so it becomes useful as a shared decision-making tool for both patients and providers.

What components of a report are helpful to the patient?

Brevity. Patient understanding of radiology reports is inversely correlated with report length. Structured reports with subheadings for organ systems in the findings section make it easier for providers and patients to locate pertinent negative or positive findings. Including images in a report can improve patient understanding. A patient may not understand the terms “rales” or “ronchi” on an office physical exam note. However, they are more likely to understand they have pneumonia when they see a white area in their lung base surrounded by normal black lung tissue.

In addition, including the name and contact information of the interpreting radiologist within a report can make it easier for patients and ordering providers to reach you directly with questions. And no, there is no significant increase in phone calls reported by radiologists who do this. Finally, patients want their results quickly. We need to dictate results in a timely fashion, offer patients an opportunity to review their results with a radiologist if they desire, and decrease the time it takes to post results through online portals.

Should radiologists use the word “normal” in a report?
Radiologists fear the word “normal,” I believe, because of medicolegal concerns. If an organ is not normal and you say it is, you have falsely reassured the patient and opened yourself up to a lawsuit. We come up with other terms in lieu of normal, such as “unremarkable.” However, an interpretive error that contributes to patient harm is a potential liability, regardless of the language used. If we didn’t see an abnormality, it doesn’t matter if you said normal, unremarkable, or wrote 30 sentences of prose iterating what you didn’t see. I like to use the word “normal” because it is brief and reassuring. A lot of the macros in my practice include the word “unremarkable.” There are only so many times in a day I can remove it. What I find amusing is that you literally remarked on something — so it’s not unremarkable!

What’s at stake if radiology reports stay the same?
I mentioned earlier that the report is our product. That’s true, but it’s not our end game. The true measure of a successful radiology report is whether it communicates useful information to the provider and patient — and leads to an educated discussion that includes the radiologist. Even if patients don’t understand every word, they should understand the salient points and start to generate questions about how the results relate to the symptoms that lead to the test and possible next steps. We want patients to become more involved in their own healthcare. We want them to understand their results and how to act on them. We can move the needle on this by changing how we write our reports.