Imagine this hypothetical scenario:
Over time, as more and more follow-up scans of your brain lesion are performed, the reports grow more and more confusing – because they are inconsistent. Is the lesion larger, smaller, or the same as before? And why can’t the radiologists agree from scan to scan?
It’s an important question for you and for the neurosurgeon, after all, because:
- It is one of the important factors determining whether you need surgery.
- It can help determine whether therapy is having an effect.
- Imaging is the only way to make a determination of lesion size.
A common reason for this frustrating and sometimes dangerous variation in the radiologists’ assessments of changes in lesions over time? The fact that relevant prior exams are often not available, or are not reviewed, by the radiologist reading a scan on any particular day. The radiologist will often compare your new scan only to the most recent prior exam, if they make a comparison at all.
Why does that matter?
Unfortunately, this approach means that subtle changes over time, such as those seen with slow-growing tumors, may not be recognized or reported. This can directly affect patient care.
It’s an avoidable error, but it happens often because it takes extra time to compare a scan to another scan, and it takes even more time to compare a scan to more than one prior scan. And, in medicine, radiologists are under tremendous time pressure.
If I were this patient, I would want an expert whom I trust to take the time to go through prior relevant exams and compare them to one another over long followup periods. That’s simply the best way to make an accurate decision about what my lesion is doing – growing, staying the same, or decreasing in size. As a sub-specialist radiologist, it is a task I frequently perform, and I know that it is important to do if time allows.
In addition, radiologists look for specific issues based on what they perceive to be the clinical question at hand. If we’re lacking an accurate and complete history, then our decisions regarding where to focus our attention will be suboptimal.
Unfortunately, due to the realities of time pressure and limited access to clinical information and prior imaging exams, radiologists usually lack a complete, fully accurate history in modern medicine.
This raises another reason I founded MD For Patients: I believe physicians do their best work when thoroughness – not the number of cases processed per hour – is rewarded. So I designed MD For Patients to be a practice that does not penalize its physicians for taking the time necessary to do their best work. In other words, the work that is required in order to make an accurate, fully-informed diagnosis. It’s the right way to do things, and it’s the best way to ensure that this part of the diagnostic process is done well.
If you or your loved one is seeking a second opinion regarding an MRI scan, CT scan, other radiology exam, or in other specialties, we are here to help. This series is focused on busting radiology myths, but widespread problems like incomplete access to prior test data, excessive time pressure on providers, and sub-specialist shortages affect patient care and are not unique to radiology. They affect all of modern healthcare.
Stay tuned for more mythbusting.
