Personal Consult With Radiologist?

A radiologist has rated me as Birad4, recommended stereotactic biopsy for calcifications.  At no time has the radiologist met with me, gone over my films or shown me what on the mammo is of concern.  I got my films (on paper print out) from medical records and took them with me to my surgeon consult. He did not  read the films nor make any indication of a desire or ability to read them for me.  My internist will not do so either....they all seem to pass the buck back to the radiologist.  Here's my question:  shouldn't I have the right to a face to face, sit-down consult with the radiologist, have him put these films up on a lightbox or computer screen and show me exactly what he's looking at which leads him to recommend biopsy?  So far, no one has done so.  And will I be charged for this?  Isn't it standard for the radiologist to speak with a patient Birad4 about the findings?  If not, how on earth would a patient be able to be fully informed? If I had a broken leg and wanted to see where the fracture was, I'm sure a radiologist would be happy to show me.  So far, the breast radiologist is not.  Thank you for further info on the protocol regarding this type of consult or how it's generally handled in the medical world.  

[bluebutterfly2222]

I have never had a radiologist discuss ANYTHING with me (except one, who was a personal friend and accompanied with me when I had a CAT scan).  Generally, interpreting radiologists just study the images, prepare reports, and send them to the referring physicians.

This is similar to the case with bloodwork and other lab tests such as Pap smears,  and pathology reports from biopsies, where the results are sent to the referring physician (and sometimes the  patient as well) .

However, if you are having a dx mammogram, sometimes the radiologist will talk with you directly (esp. if you are a BC patient/survivor who is being seen for follow-up evaluations); or if you are dealing with an interventional radiologist (who might be doing a needle or core biopsy for example), s/he would meet with you in person; and of course if you are having radiation txs the radiation oncologist will meet with you at various times.

If you succeed in getting the radiologist to meet with you, you should expect to pay for the consultation, since this would be a separate service from reviewing films and preparing a report.

I'm a bit surprised the surgeon didn't go over the films with you, as this is often part of explaining the procedure that will be done, although perhaps more often when a lumpectomy or mastectomy is under consideration for a known cancer, rather than in the case of a routine biopsy...

Best wishes,
bluebutterfly

[bluebutterfly2222]

p.s. I don't know where you live, but in most places, I believe it would also be unusual  that a radiologist who dx a leg fracture "would be happy to meet with you  to discuss your X-ray..."

Again, it would more  likely be the orthopedic surgeon who was treating you who  would go over your images with you.

Regards,
bb

[needtoknow492]

Thanks so much for your response!  It's so interesting, in other forums, I've seen patients who said, "and then the radiologist came out and spoke with me after the mammogram".  I was fully expecting that ater my diagnostic mammo,  I would have at least a brief consult with the doctor who read the films....esp. for a Birad4/biopsy recommended procedure.  When that didn't happen, I fully expected the surgeon to go over the films with me (yes, it's for a biopsy only at this point, but I still have had no one actually sit with me an interpret the films and show me precisely what's what).  I feel a radiology report which recommends an invasive procedure is somewhat different than a blood test...usually one's doctor can fully explain and discuss all bloodwork and recommendations.  

However, that's not the case with radiology films.  I also do not know why the surgeon made no effort whatsoever to go over the films with me.....he didn't even bring them into the room with him.  To me, that was a big signal not to do any further business with him ( he's a general surgeon, so I wouldn't use him anyway if it came down to further surgery necessary after the biopsy, I'd go with a breast surgeon. I went to him because he was who I was referred to).

I think this is an area which really needs to be explored more - the lack of one to one consult between radiologists and patients.  It's as if radiologists are somewhat hiding behind their doors and expecting that we, as patients, will go into biopsy procedures based on a written finding alone, with no further input from a surgeon or own own internists.  Yes, I presume I wll be charged for a special consult which I feel isn't fair since in my opinion, the consult should be part of the radiology test, and apparently for some patients it does happen that way, as I've certainly seen a number of patients say they had at least a brief chat with the doctor who read the films (certainly birad4 and 5 patients).  It's all part of the learning process and it's great we can all share our experiences so others can compare and find out what's done or not done in the medical world.  

I am going to request a face to face consult with the radiologist., Maybe my HMO will pay for it, probably not if it's not the "usual" thing.  When it's something as serious as recommending ANY type of invasive procedure into my body, I want to know everything I can, from A-Z, and I certainly want the microcalcifications pointed out to me, described, shown and discussed.  If the radiologist can't or won't do that.....my trust levels start to spiral downward and that's not what the medical world should be seeking.  The radiology report itself was vague in my opinion.  They should seek and want our trust and this isn't the way to get it.  Thank you again for your input, I will keep you posted!

[needtoknow492]

I agree that in the case of a leg fracture, the orthpedic surgeon would put the images up and show you exactly where the fracture was.  In such cases, I agree that the radiologist doesn't need to consult if there's another medical professional in the position to fully show the patient the films and explain the films.  This isn't what's going on in breast mammography and that's what I do not like.  This seems to be an arena all unto itself, and as you can see, the surgeon didn't even have the films with him when he came into the office and basically refused to go over them with me, because the radiologist is the expert in that field and "they have super magnification ways to view things" etc etc. So, clearly in the area of breast imagining, a patient who wants to have the actual films explained and discussed, must intervene and be pro-active. I find this troublesome.  

[bluebutterfly2222]

The presence and role of a radiologist at dx mammos varies greatly from facility to facility.

There have even been "debates" among some of our most knowledgeable answerers, because some of us  DEFINE a dx mammo as one where the radiologist is there and gives an immediate answer, whereas others of us have experienced dx mammos where the images are relayed to the radiologist by computer, and the only information provided that day is that the images are clear and the radiologist has all the views s/he needs. You then go home and wait to learn your fate...

Obviously the first approach is  desirable and vastly better for the pt., but with the shortage of radiologists in many areas, mammos are sometimes  difficult to even schedule, and the  radiologists must read and dictate in regard to a huge number of images per day, and have no time to meet with pts who frequently would  want long, detailed discussions with them.

Since the patient is sheduled for a consultation with the surgeon or interventional radiologist who willl to actually perform the procedure, this is the first opportunity for many pts to understand their results and have all their questions answered. Anyone who does not feel trust, confidence, and a reasonable amount of rapport with the surgeon should arrange a consult with another surgeon if at all possible.

I hope you are able to get everything arranged to your satisfaction!

Please do keep us posted--we care!

bb

[bluebutterfly2222]

In case you are interested, here is a link to a previous thread where I provided information about breast calicifcations/"microcalcs:"

http://www.medhelp.org/posts/Breast-Cancer/Microcalcifications---just-wondering/show/1443586

And here is a link to an article that includes mammograms showing many different types of benign calcifications:

http://emedicine.medscape.com/article/347066-overview#a30

I think it gives an idea of why interpreting mammograms is not any easy job! (Be sure to click over to the 2nd page to see more pictures.)

[needtoknow492]

Thanks so much for the info....I was somewhat aware that there are widely varying protocols as to how radiologists interact with patients and also the very high workload some of these imaging centers handle.  That's why I was amazed and extremely annoyed/shocked that the surgeon didn't fill the void in terms of looking at the films with me.  I had brought the films to him three days before my appt. and I presume he may have looked at them at some point himself (who knows), but as indicated ,he would not look at them with me nor in any way assist in interpreting the visual images. So, there was no one on the "team" available or able to show me the films and say, "here's the suspicious cluster of microcalcs we're worried about, here's the linear set of calcs referred to on the film, there are X number of calcs in this cluster," etc. That's what I need to get and that's what I'm going to get, no matter what. Whether it changes the recommendation for biopsy or not is beside the point for me.  It's all about me knowing fully what I'm getting into here and not letting anything slide.  If they can't  show  me what's there and why I'm being asked to have a needle stuck in me and tissue removed, then I'll for sure find out why.

God knows I wouldn't know what I'd do in this situation without these forums and the Internet and links provided by so many helpful patients and moderators.  The medical profession certainly isn't giving me the info I fully need to make an informed decision.  I had my first abnormal mammo in July and the diagnostic mammo in September (no apparent change or increase in calcs between the two mammograms within an approximate 3 month period).
So, my first line of defense is to request a consult with the faceless radiologist who wrote the report.  Then my second line of defense is going to be to get the CD of my film (they only gave me the paper copy) and have that CD read by an outside facility, probably also out of my own pocket.  Then and only then will I even consider biopsy.  The  radiology report is entirely too unspecific for me as to the calcs.  So, I will post again and let everyone know how it went.  I truly don't care how picky the doctors think I'm being or questioning their expertise or whatever.  It won't be them lying face down with their breast hanging through a hole in a table with a needle shooting in.  It'll be me.  So I want to be sure I am truly doing the right thing and not rushing something that could be watched. I've done four solid months almost 24/7 of research online so I realize how hotly debated so much of breast treatment, diagnosis, etc. is.  I'm aware.  And that's precisely why I feel that I must be  careful and wary.  Each person's situation is different depending on what their report says, so I certainly respect that.  I just feel there needs to be a total one-on-one consult with the visuals of the actual films fully gone over with the patient, whether that is done by the radiologist, the surgeon, or someone else on the breast imaging team.  Or at least there should be an option of the patient to request it at no charge as part of the overall evaluation.  But I guess that's another topic for another day lol.....

[needtoknow492]

This is a follow up to my previous posts, as I would like everyone to know how things are progressing.  I finally have an appt. next week to meet with a radiologist about my mammogram.  It's been an interesting experience just trying to get this far.  At first, I was told that I could find out more on the day of the biopsy (NOT!).  I told the radiology dept. that I wanted to sit down face to face like a normal  consult and be told point by point why I am being told to get a biopsy.  oh, and btw, I am NOT being charged for this consult (interesting, I assumed I would be, but I have been assured there will be no charge, and that is as it should be!  Why should i be charged for a consult which should be done whenever an invasive procedure of this sort is being recommended by some radiologist behind a door?)  I am very proud of myself for having gotten this far and intend to continue on getting more and more questions answered.  I, for one, do NOT like the attitude of "just get a biopsy" without a formal consult. Since my internist nor the surgeon had any interest or desire or time or experience to go over the films with me, the radiologist is clearly the person who legally should do it.  I again would urge every woman reading this to be vigilant and not just jump into a biopsy without full understanding and informed consent and that includes a full consult with the radiologist. An interesting point on this: the radiologist who will be going over this with me is NOT the one who recommended the biopsy, but the one who "concurred".  Her name is not on the radiology report, but another guy's name.  I won't be seeing him...hmmm, interesting.  So, it truly is important to dig in and find out what's what.  So, that's the latest.  Don't take anything for granted and don't be shoved around or shoved off no matter what.  

[bluebutterfly2222]

Thanks for the update; we'll be waiting to hear the next developments.

bb

[needtoknow492]

I certainly will, and I feel  that the reason  I'm not being charged for this radiological  consult is proof positive that they KNOW they are obliged to answer a patient's questions when a biopsy is being recommended.  I've gotten more info from my mechanic about my car than I have about this entire matter and these medical professionals get a bit nervous when a patient finally puts their foot down and says, "I want a face to face consult with the doctor recommending this procedure.". So.........."no charge"....no need for an insurance referral, no need for paperwork, NO CHARGE.  It's a pity that we as patients have become so used to being treated like ATM machines that we sometimes wrongly assume that if we ask for info that is rightfully ours and should have been given to us carefully and respectfully and thoroughly at the outset, that we will be charged for it.    Maybe if enough of us stand up, this mindset will change and there will be improvement for all of us.  I hope so.        

[needtoknow492]

This is an update to the above.  I finally had a consult if you can call it that with the radiologist.  It was very brief, about 15 minutes.  As previously indicated, it was not with the radiologist whose name appears on the report but with the concurring radiologist who  primarily does breast imaging.  I met with her in the room where she looks at the mammograms and she had my films up on her viewer. I asked a few general questions and I looked more closely at a particular area that I wanted to see more closely.  She wasn't hostile or defensive, but said practically nothing, replied mainly in "yes" and "no" type answers, which I didn't find to be an indication of a very open conversation.  However, with the medical/legal environment that doctors are forced to function in these days, I understand the bind she is in.  I asked her to measure the calcs that were found (no measurement had been provided in the original report). She did so - 9.6mm which she confirmed is very small.  However, size doesn't indicate whether something is b9 or malig. only that it is small (I already knew that of course).
About the only thing I can say that was somewhat different about her approach vs. the approach of my internist and a general surgeon is that she never bullied me or used language in a particular attempt to terrorize me into having this biopsy immediately.  She simply said, "this needs to be biopsied." I explained to her some other issues going on with me, that I have no one (no family) currently in town with me because of having just moved to a new city and that I also suffer from another health issue that impacts my decisions as to getting into invasive procedures.  She listened to that, nodded, remained neutral. She said, "it's your body". which I appreciated at least that she stated a fact. It is my body. I agreed with her on that obvious fact and said that the bottom line as to if/when I have this biopsy remains with me.  She said, "yes, it does."  

Even though I can't get inside her head to know what she is really thinking about this small lesion of calcs, it MAY be that she didn't want to lose her own credibiility by putting on an exagerrated act, one way or the other, about the pressing necessity to do the biopsy immediately (as the other doctors have done).  That's my gut instinct on her not going into a meltdown after hearing MY personal issues and my side of the problem, that there was really no way I could have this biopsy for at least 3-4 months.  Every patient has to weigh the medical findings with their own personal situation and I am doing so in a highly proactive way.  That's why I want to share my story here so that maybe other patients who are currently weighing options will know they are not alone and if you need the time to weigh things, then do so.  Each case is unique.  I also told her that I was very aware of the debate about the overtreatment and/or overdiagnosis of DCIS.  She simply nodded....didn't add anything to that one way or the other, but she wasn't hostile or defensive about it either.  So, again, I feel she knows there's gray areas in treatment or approach and the whole patient has to be considered. I told her that I was aware that calcs might not change for 5 yrs or more.  Again, she nodded yes to that.  But we do know that things can change, and as an informed patient, I am aware of that.  I'm aware that there's a 0 to 100% chance of anything happening at any time to any one, but that's not really the point.  The point is that I have to look at this in an overall context.

My next step is to see my internist in a couple of week and tell him what my current situation is. At this time, I am leaning toward doing a six month re-test around March or April.  I'm also aware of the issues surrounding that but I think I'm a good candidate for doing at least ONE round of "watchful" observation before jumping to biopsy based on the lesion found.  I am also going to get a second opinion reading of the mammogram from an outside radiologist. The original report is quite vague as to size or morphology of the calcs.  I believe it's well worth my time to obtain at least a more specific report.  I am also going to obtain my previous mammo films from 10 yrs ago.  True, they are old, but I still want all the info available, and the radiologist said that was fine.  She said she doubted the calcs would show on that which I agreed was probably the case, but I said I wanted them anyway and she was certainly okay with that and also said she could read them and make a comparison with these digital films.  So, that will be done also.  All these things are important to do, even though they may not give us a lot of info, but one never knows.  

I do not feel I am doing anything reckless or stupid with my health at this juncture. If I continue to be  bullied or pressured by my internist then I will have to go elsewhere which will be a big burden on me because I'm in a very limited HMO with few to choose from.  I realize many women are in my position, and we aren't able to just hop around to any doc we want.  So, that's the latest.  I wlil continue to update when I can. I hope my sharing here informs or assists others in similar situations.  Again, every person must decide for themselves based on the findings from their test results, their own research, and their own health situation.