As a doctor, we know that history is the most important thing that a patient can provide to their doctors to help make the diagnosis. It is well known amongst doctors that 80% of patient diagnoses can be made by history alone without any lab tests or imaging exams. There is a role for screening imaging exams in radiology although when a patient is symptomatic that is not the time to perform a screening examination. When a patient is symptomatic then the history should be obtained and then the imaging test ordered can be chosen based on the patient’s history and symptoms.
Unfortunately, this is often not the case at all. As the health care system has continued to not be able to effectively treat the volume of patients the information provided to the radiologist as history has declined and patients have subsequently suffered. Patients are having exams performed in the emergency rooms across the country without their doctors taking a complete history and performing a physical exam. Instead, a nurse may ask the patient a few questions, take the patient’s vital signs, and then the doctor will come in and tell the patient that they are ordering a CT study.
As a radiologist, I made an interpretation the other day on a non-contrast abdomen CT which came in with the history of “pain”. As I started looking at the 400 images that made up this patient’s examination it was clear to me that they had some type of cancer. There were lesions in the liver, there were enlarged lymph nodes, and the patient had surgical changes that reflected they had a part of their colon removed previously. I called the ER to ask for further history and was told that they did not have time to get a detailed history yet. I deduced that the patient had colon cancer previously removed and thus the surgical changes. However, now the lesions to the liver and enlarged lymph nodes were much more likely to be spread of their cancer. Had the ordering clinician given the patient history, this CT would have been performed with a different CT protocol improving diagnostic accuracy for the patient. As well by not sharing patient history, it forces the radiologist to have to make assumptions that may or may not be correct not only opening the door for mistakes to be made but also leading to an interpretation with much less detail and correlation to your medical problems.
The Medical Consultant gives you the opportunity to provide a very detailed history and we know that this improves our diagnostic accuracy in interpreting your imaging exams.