Dealing with Questions

Over on our March 14th Mammography Matters blog, Wanda Francisco discussed dealing with the questions of patients who wanted to know what they were seeing on the screens of the new digital mammogram machines .

It seems that some of the digital mammography systems allow the monitors to face the patients and she wanted to know how mammographers dealt with patients questions.

While CT, MR and even PET systems have the monitors in separate rooms, nuclear medicine SPECT cameras often put the processing systems, including the monitors, in the same room as the patients.

Many years ago, when I was working in nuclear medicine, my SPECT system had processing and imaging monitors facing out into the imaging room where they were visible to anyone accompanying the patient and even to some of the patients, for instance the renal patients sitting with their back to the camera for a dynamic study.

The problems came when someone accompanied a patient for a bone scan and the images on the monitor showed a lot of intense uptake in multiple metastases. Even those with little knowledge of anatomy or nuclear medicine could get an idea that there was definitely something wrong. Because there was no way to turn these monitors in another direction, I would usually darken the monitor during any scans where the images might cause concerns if seen by others in the room.

When asked what I saw, I would say that the images needed processing before the doctor could interpret them.  

Other times, I would get a patient in for a thyroid scan because a lump or enlargement in the thyroid caused concerns of possible thyroid cancer.  They would also ask what I saw. I hated to send them home worried, when it was pretty obvious from the image that the nodule was something benign. Since I could not answer their question, I instead explained there are a lot of different reasons for a thyroid to be enlarged and most of the time it was not cancer but something else that could be easily treated, so they should try to not to worry too much while they waited to hear the results from their physician.

Of course, it was not nearly as easy when a physician came by and wanted to know what I had seen on a scan they had ordered. I would say "Dr XXX has not read the study yet", but they knew that I had the knowledge to read most scans. I know that many technologists have had this problem, as a few years ago the SNMTS did a survey in which most technologists replied that they had indeed been asked to give opinions on scans.

Are your imaging monitors visible to patients at your hospital? Have you even been asked by a physician to give an opinion on a scan? If so, how do you handle the questions from patients and physicians at your facility?