Radiologists and incidental imaging findings

A group of radiologists from several American university hospitals (Massachusetts General, Cleveland, Brigham and Women's, etc.) started a debate in the Journal of the American College of Radiology about the eventuality that radiologists would stop reporting the incidental imaging findings lacking clinical significance. "The traditional role of the radiologist," they say, "is to warn of everything they see, leaving the interpretation of the findings’ relevance to the referring physician”. However, we now open the opportunity to go further, and not just intervene by saying, for example, that an observed abnormality is benign, but also taking the decision not to report the milder ones, given the possibility that our opinion generates confusion and ends up causing excessive medical actions".

Regarding level I renal cysts of the Bosnian classification

The radiologists who authored the article used the findings of renal cysts, which are very frequent with a prevalence of 36% in patients over 80 years of age, in order not to inform of renal cysts of level I of the Bosnian classification in their reports, in accordance with the following criteria: a) the cyst is not the reason for the examination, b) doesn’t generate local problems, c) has no malignant potential, and d) is not likely to generate a polycystic kidney disease.

How about the Patient Experience?

David Font

In my previous post, I talked about the formula E = mc2, that is, to achieve excellence (E) we need the commitment of workers (c), trust in the institutional project of the governing bodies and health officials (c from confide) and the appropriate methodological development (m). I would like to delve into the methodology and in particular on the importance of the patient experience when deploying improvement projects and consider it as a priority in the strategic development of our institutions.

The public health system methodically evaluates patient satisfaction which allows us to obtain global information regarding users’ perception. However, we abuse studies that are too general and in which the evaluation differs excessively when it comes to the time dedicated to healthcare. These and other methodological limitations make it difficult to draw conclusions and the possibility of using the information related to the patient's experience as a source of identifying opportunities for improvement is also an element that limited by cultural aspects. To expand on these aspects, it’s interesting to read the articles "The Patient Experience and Health Outcomes" Matthew P et al [1] and "Collecting data on patient experience is not enough: they must be used to Improve care" A Coulter et al [2].

How to involve doctors in transforming the health system

All health systems need to streamline costs while solving a lot of complex problems and  improving health outcomes. We’re dealing then with difficult challenges that are almost impossible without the doctors’ involvement, and for this reason I found this article to be very relevant: "Engaging Doctors in the Health Care Revolution" by Thomas Lee and Toby Cosgrove, from Harvard Business Review, as they are seeking solutions from Max Weber and his 4 fundamental motivations for social actions.

Motivation 1. Look for noble targets

When managers and doctors meet up, they ought to discuss patients, quality and results, and if they really want to change the status quo, they should not wonder away from this script. The conversation, therefore, should never start with contracts and compensations, this topic ought to be reserved, if at all, for the end of the meeting, after the main topics. Managers ought to listen, assess the views and know how to create a process in which all parties should have the opportunity to add their personal touches to the final process. A basic script of 3 points that the authors extracted from Mayo Clinic should be kept in mind: a) at the time of sitting down for the discussion, everyone should be very clear that things can not continue as they are; change is needed, b) the transformative project that arises must be clearly focused on the patient, and c) this is a path on which all involved actors will walk together.