Wednesday, April 08, 2009
Doctors and Patients
An article in Monday's New York Times told about a radiologist who experimented with attaching a digital photograph of a patient (the outside of a patient, that is) to the patient's digital CT or MRI scans to see how doing so affected radiologists' interpretation of those scans. The abstract of his findings includes these results:
The Times article also implied that attaching a photo could have a similar effect on "pathologists and other doctors who rarely have contact with patients."
This reminded me of something that happened not long after Jane was first diagnosed with her brain tumor back in 1998. Our monthly support group at UC Davis Medical Center followed a format in which we'd alternate between open discussion one month (we called it "sharing") and a guest speaker the next. One month, the neuro-pathologist who had prepared Jane's initial pathology report -- a report that was quite dire in its prognosis -- was to be the speaker. (I'm embarrassed to admit I don't recall his name, but I remember that he looked like a guy who spent his days in a dark room performing experiments and looking through microscopes -- pale, rumpled, hunched.) We listened to his presentation, and learned a lot about how brain tumors were identified and classified. After the talk, Jane approached him, pathology report in hand.
Never a shrinking violet, she asked him to read and autograph the report. He was startled but polite; he looked at the report, looked at a very healthy and alert Jane, and said, "Clearly, I didn't know what the hell I was talking about." A huge smile broke across his face, and he autographed the report with a flourish.
We related this story a few times over the years, and the reaction was almost always the same. Our fellow travelers were happy that we had beaten the odds, proved the expert wrong, and got to tell him to his face. (One person was not amused, saying, "I would have sued his ass on the spot.")
I'm pretty certain that that pathologist learned as much that day as we did. By connecting a face, a personality, a person to that tiny "rat bite" of tissue on his microscope slide, he learned that his work exists in the context of real lives and that his words matter. This wouldn't mean that he should be overly optimistic in his reports, but it did mean that he had an obligation to be as precise, accurate, and honest as possible. It's a lesson that the radiologists in the above-mentioned study also seem to have learned.
All radiologists felt more empathy to the patients after seeing the photograph. The photographs revealed medical information such as suffering or physical signs of disease. Out of the 30 cases which were presented twice, in 80% the incidental findings were not reported when the photograph was omitted from the file. All radiologists involved reported that the addition of the photograph did not lengthen the duration of the examination, however did render the interpretation more meticulous. All recommended adopting this idea to routine practice.
The Times article also implied that attaching a photo could have a similar effect on "pathologists and other doctors who rarely have contact with patients."
This reminded me of something that happened not long after Jane was first diagnosed with her brain tumor back in 1998. Our monthly support group at UC Davis Medical Center followed a format in which we'd alternate between open discussion one month (we called it "sharing") and a guest speaker the next. One month, the neuro-pathologist who had prepared Jane's initial pathology report -- a report that was quite dire in its prognosis -- was to be the speaker. (I'm embarrassed to admit I don't recall his name, but I remember that he looked like a guy who spent his days in a dark room performing experiments and looking through microscopes -- pale, rumpled, hunched.) We listened to his presentation, and learned a lot about how brain tumors were identified and classified. After the talk, Jane approached him, pathology report in hand.
Never a shrinking violet, she asked him to read and autograph the report. He was startled but polite; he looked at the report, looked at a very healthy and alert Jane, and said, "Clearly, I didn't know what the hell I was talking about." A huge smile broke across his face, and he autographed the report with a flourish.
We related this story a few times over the years, and the reaction was almost always the same. Our fellow travelers were happy that we had beaten the odds, proved the expert wrong, and got to tell him to his face. (One person was not amused, saying, "I would have sued his ass on the spot.")
I'm pretty certain that that pathologist learned as much that day as we did. By connecting a face, a personality, a person to that tiny "rat bite" of tissue on his microscope slide, he learned that his work exists in the context of real lives and that his words matter. This wouldn't mean that he should be overly optimistic in his reports, but it did mean that he had an obligation to be as precise, accurate, and honest as possible. It's a lesson that the radiologists in the above-mentioned study also seem to have learned.
Labels: brain tumor, health, Jane, medicine, news, people, personal history, science, work
# posted by F.S. @ 9:49 AM 
