JACR: Write well or face the judgment of the patient portal

The rise of online patient portals is presenting radiologists with a golden opportunity and a formidable challenge. The opportunity: beat back market forces pushing the specialty toward commoditization. The challenge: master a new reporting language that remains sufficiently scientific for referring doctors yet becomes broadly accessible to medical laypersons—also known as “patients.”

That’s one way to characterize the gist of an open letter from five writerly radiologists to their peers in the September edition of the Journal of the American College of Radiology. Led by Michael Bruno, MS, MD, of Penn State, the authors imply a strong case for radiologists at all levels of experience to receive basic training in verbal expression. To that end, Bruno and another co-author have been offering “report clarity writer’s workshops” to radiology residents at Penn State’s Milton S. Hershey Medical Center.

“A poorly organized, confusing, or internally inconsistent report with misspellings and typos can erode patient confidence in their provider’s work and even their institution,” the letter states. “By extension, sloppy reports may render radiologists economically vulnerable in competitive markets. They may also create potent medicoelegal liability, and in the age of web portals, evidence of liability may be directly delivered into patients’ hands.”

Web-based patient portals are a natural development in a wired world demanding transparency. It’s also no surprise that, because they give patients 24-hour access to their own medical records, such portals are a mandated means of provider-patient communication, thanks to Meaningful Use stage 2. However, the authors contend, the positive incentives for writing clearer radiology reports are even more compelling than the punitive. “Patient portals may ultimately prove to be one of the most powerful tools radiologists have to enhance the value they bring to health care,” they write.

The drive to offer patients direct access to their radiology reports has been gathering steam for some time. In 2007, the American Journal of Roentgenology ran an article titled “Communicating Results of All Radiologic Examinations Directly to Patients: Has the Time Come?” In 2009, the American Recovery and Reinvestment Act’s HITECH section allocated almost $20 billion to speed implementation of EMR systems, stressing the incorporation of patient portals.

By now the momentum has finally reached the point where, as the authors put it, the “patient web portal is a ‘train that has left the station.’ It is a nationwide reality, alongside public and professional expectations regarding transparent communication. Radiologists can help control the process or passively comply as others formulate key policies about patient access to radiological reports. Radiologists have much to gain by leading the discourse and much to lose by avoiding it.”

The letter lays out a handful of tips and pointers for more patient-friendly report writing. Among the suggestions: Avoid excessive jargon; convey uncertainty forthrightly; be sensitive to the patient, but do not unduly avoid sensitive topics; make evidence-based recommendations; document all direct communication; and proofread.

Click here to read the full text of “The ‘Open Letter’: Radiologists’ Reports in the Era of Patient Web Portals” (which is new to print but has been online since May).