Health Scan: Knowing what a patient looks like improves care

Jerusalem radiologist finds doctors read X-rays better if they're familiar with the faces behind the images.

By JUDY SIEGEL-ITZKOVICH
health scan 88 (photo credit: )
health scan 88
(photo credit: )
Radiologists give better assessments of patients' X-rays when they are familiar with the person behind the images - even if they've only seen photographs of their faces. This has been proven in a pilot study by Shaare Zedek Medical Center radiologist Dr. Jonathan Turner. He realized that he was constantly looking over patient files, X-rays and images but was unable to develop any real bond with patients because they never really came into contact with him. From that premise, he hypothesized that if in addition to seeing X-rays, a radiologist viewed an actual picture of a patient's face, things might be different. He got consent from several hundred patients to have their photo taken before undergoing an X-ray, and the picture was included in their files. The results, which have just been presented at the Radiological Society of North America Conference in Chicago, found that radiologists wrote substantially longer reports and were more thorough in their analyses when they were able to establish an "emotional connection." These findings could alter the field of radiology and other medical disciplines such as pathology - in which interaction with patients is almost nonexistent - by giving a face to the file and thus adding empathy, said Turner. It could even become a standard in these fields, should it be proven to also aid patient care. Particularly today when radiology is almost exclusively digital and a radiologist can be thousands of kilometers from the patient, he added, establishing an emotional bond is an important development. DIFFERENT STROKES FOR DIFFERENT FOLKS Many people have a "silent stroke" without being aware of it. Researchers at the Mayo Clinic in the US note that a majority of stroke patients don't think they're having a stroke, causing them to delay treatment. Dr. Latha Stead and colleagues studied 400 patients diagnosed at the famed center's emergency department with either acute ischemic stroke or a transient ischemic attack (a temporary interruption of blood flow to part of the brain). Forty-two percent say they thought they were having a stroke, but most did not go to the emergency room when symptoms appeared. The median time from onset of symptoms to arrival at the hospital was nearly four hours, and most said they thought the symptoms would simply go away. Hadassah University Medical Center Prof. Jose Cohen, one of the country's leading experts in interventional stroke treatment, comments that a recent article from the respected Framingham Study suggests that 1 in 10 people with a mean age of 52 who believe they are stroke free have had a 'silent' stroke. Cohen adds that 'silent' is a misnomer, and that they should be called 'subclinical' strokes. "When subjects with so-called silent infarctions are examined, they have subtle neuropsychological and neurological deficits. These deficits may involve attention, cognition, mood, memory, speech and other complex skills. These strokes are caused by the usual vascular risk factors such as hypertension, smoking, diabetes, high cholesterol and cardiac disease. These 'little strokes' could spell a big trouble, as one subclinical stroke increases the risk of having more, and of experiencing a clinical stroke and/or dementia. It's important to recognize symptoms that elderly people manifest such as changes in judgement or intellectual ability and personality changes may be due to subclinical strokes and other changes in the brain. We should treat risk factors with renewed vigor." Signs of conventional strokes include sudden numbness, weakness, or paralysis of the face, arm or leg; sudden difficulty speaking or blurred, double or decreased vision; sudden dizziness or loss of balance: a sudden, severe "bolt out of the blue" headache or an unusual headache; and confusion or problems with memory, spatial orientation or perception. FEWER TINY PREMIES There are numerous negative trends in medicine, such as the rise of obesity and chronic disease and the failure to make a major dent in cancer, so it's good to hear a positive trend: The number of babies born at a very low birth weight has declined significantly in recent years due to improved prenatal supervision, the return of fewer embryos to the womb for in-vitro fertilization, increased giving of steroids before birth to "ripen" the fetus's lungs and higher rates of cesarean sections in high-risk women. The Health Ministry noted this change in its new report on very-low-birth-weight infants (VLBW) for 2006 (the latest year for which statistics have been processed). The improved trend is important not only because VLBW babies are more likely to die and survivors to suffer from serious disability, but because treatment in neonatal intensive-care units is prolonged and very expensive. In 2006, the births of 1,443 babies weighing 1,500 grams or less were reported. In 2005, the figure was 1,497 and in 2000, it was 1,648. There is also a decline in the number of babies born before the 26th week of gestation (normal is 40 weeks); babies born weighing less than 500 grams and the number of multiple pregnancies and births. Because babies are being born later and weighing more, the death rates for VLBW babies has dropped from 19.7% in 1999-2000 to 16.1% in 2006. In addition, fewer VLBW babies who survive suffer from respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis and other conditions. New technologies such as "lung ripening" and high-frequency ventilation after birth increases the chances of very small newborns. Women, especially those from low socioeconomic levels, are given more intensive monitoring during pregnancy to reduce the risk of premature delivery.