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Thursday, June 21, 2012

Out of the closet: Second opinions on Radiology tests

Dr. Greg Goldstein's story:
One of my patients, a relatively young woman I'll call Lauren, had had pain in her calf, with swelling, so she went to the Emergency Room to get an ultrasound.  They told her they saw a clot in the scan, so she'd need a few days of hospitalization, to be on blood thinners ["anti-coagulants"].  That treatment isn't benign, as there's a risk of bleeding as a side effect.  She called me and asked me to look at the ultrasound.  I looked, and didn't see a clot, so I suggested she have another ultrasound to confirm it.  She went to a vascular surgeon, who repeated the ultrasound, and also found nothing there.  She could've been put on Warfarin for a period of time, maybe indefinitely, so we prevented that.  That was good for her, and was also good from a public health perspective, as the money for the unneeded anti-coagulant drug was saved.

As my own Radiology practice grew, I learned about the importance of communication between the primary care doctor and the radiologist, and providing a high level of service.  I thought, Why shouldn't radiologists talk to patients?  Why be only behind the scenes, when we're in a unique position seeing doctors and patients from all specialties?  We're coming out of the closet.  That's important because patients are getting very frustrated, saying, "My doctor didn't have time to go over the film with me, and didn't explain things clearly enough to me."  

Coming up with a medical diagnosis is like putting a complicated puzzle together.  The radiology exams are a critical piece of that puzzle - its "centerpiece."  The radiologist's unique perspective puts them in the valuable position of knowing about each specialty and can therefore help patients navigate the health care "web'."

See another story of a falsely positive scan, and see Dr. Goldstein's MetisMD website.

Thanks to Dr. Goldstein for the interview.

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