Should patients read their radiology reports ahead of the doctor who ordered the exam? That’s not a new question. It was supposed to have been settled in the affirmative by the 21st Century Cures Act.
President Barack Obama signed the bill into law in late 2016. Its provision calling for immediate and unimpeded patient access went into effect in 2021. Under the clause, providers who try to “block” patients may be hit with hefty fines.
However, of late the wisdom of the Cures Act’s lack of nuance is getting rethought. The timing may have to do with the American Medical Association’s lobbying HHS to make commonsense exceptions to the current Cures prescription for patient notification.
In any case, two opinion pieces published over the past few days exemplify the quandary.
‘The Bar for What Counts as Harm Is High’
In the “Well” section of the New York Times, author and freelance journalist Danielle Friedman begins a well-sourced article with a personal anecdote. Upon receiving an alert from MyChart, she logged in only to come face to face with an unexpected and jarring pathology report.
The Cures Act’s anti-blocking rule has surely done some good for some people, Friedman suggests.
“But it has also led to experiences like mine, in which patients are confronted with material they never wanted to see,” writes Friedman, who doesn’t single out radiology for special consideration. “Some have learned about life-altering diagnoses and developments—from cancer to chronic illness to miscarriage—through emails and online portals, left to process the information alone.”
More:
The Cures Act does offer a ‘preventing harm exception’ to its provision requiring the swift release of test results. But the bar for what counts as harm is high: The provider must be able to anticipate that the test results could lead a patient to harm himself or herself.”
En route to fleshing out the sticky situation with which this part of the Cures Act has saddled U.S. healthcare, Friedman cites an AMA survey focused on the Cures Act’s provision on test results. Around 42% of the 1,000 respondents, healthcare consumers all, wanted exam results ASAP.
Very close to the same percentage indicated they’d like to have their doctors break the news, good or bad.
“But among those who wanted instant access, more than half said that, in the case of a ‘debilitating, life-limiting or terminal illness,’ they would like to speak with a doctor first,” Friedman writes.
Regardless of which camp they fall into, she suggests, patients should ask their exam-ordering doctors for specifics on when to expect results so they can prepare mentally and emotionally.
‘Know Yourself and Your Tolerance for Possible Bad News’
Meanwhile, in commentary published by Forbes, Denver radiologist Paul Hsieh, MD, states unequivocally that he “personally favor[s] the practice of immediate release of radiology results (and other medical test results). I believe that patients have the right to know important data about their own bodies.”
That said, true to his outspoken affinity for free-market economics, Hsieh encourages patients to act as their own best mediators of medical information.
He offers three bits of advice to healthcare consumers who wish to exercise this right:
1. Understand that medical test reports are typically written with terminology aimed at physicians rather than patients. Hsieh points to the ACR/RSNA website RadiologyInfo.org.
“In particular,” he writes, “I recommend their patient-friendly pages on ‘How to Read Your Radiology Report’ and ‘Which test, procedure or treatment is best for me?’”
2. Know yourself and your tolerance for possible bad news. Hsieh warns that, whenever patients click on “View Report” in a health portal, they assume the risk of receiving troubling information.
‘Best Individual Judgment’
“If you would rather that your physician review those results with you, discussing the information within the full context of your health and your concerns, you might wish to wait,” he writes. “The new federal law offers you both the freedom—and the responsibility—to make that decision for yourself.”
3. Consider calling the radiologist for further help. “I’ve fielded many calls over the years from patients wanting to know what a particular finding on their MRI scan means,” Hsieh writes.
“I always try to answer such questions to the best of my ability,” he adds. “I (and most other radiologists) will always try to do our best for our patients.”
More Hsieh:
In summary, the health information provisions of the 21st Century Cures Act now allow patients faster access to information about their own bodies. I encourage all patients to take advantage of their rights according to their best individual judgment.”
Read the full Friedman piece here and the Hsieh column here.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.