Monday, March 9, 2009

Abnormal CAT Scans - Not Always Bad News

One of the most vexing events for patients is when they are told that there is an abnormality on a radiology study. These discussions in doctors’ offices create palpable anxiety for patients and their families, even when physicians try to reassure them that the abnormalities are likely to be trivial. Patients today are frightened that they have cancer. They all know anecdotes of individuals who were falsely reassured and were ultimately diagnosed with a malignancy. I have heard fears of cancer related to me by teenagers who have seen me as a gastroenterologist to evaluate a few drops of blood they observed on the toilet tissue. Their fear is not rationale, but it is real.

A few weekends ago, I was asked to see 2 patients on my hospital rounds to offer an opinion on abnormal CAT scans. The first patient’s scan showed an abdominal mass the size of a grapefruit that the radiologist suspected was related to the patient’s prior diagnosis of colon cancer. The second patient’s scan showed multiple lesions in her liver, which the radiologist suggested could represent metastatic cancer.

No physician looks forward to relating these ominous findings to patients and their families. Such devastating news provokes legitimate anxiety and worry, in contrast to the exaggerated concerns that patients feel after being advised of minor radiologic abnormalities.

I am not a radiologist and have only rudimentary CAT scan interpretation skills. Yet, I was able to advise both hospital patients that all would be well. How was I able to do this? Was I in a deep state of denial and issued false hope to minimize my own discomfort? Was I reclaiming the paternalism of my medical predecessors who routinely withheld serious medical information from patients? Was I so sleep deprived from phone calls through the night that I was too stuporous to function properly?

On the contrary, I was well rested and clear minded. I was able to dismiss the ominous CAT findings using a technique taught to me as a medical student over 25 years ago. Afterwards, I politely chastised the radiologists for neglecting the fundamentals that they also were taught in their training.

It only took a few minutes for me to determine that the scan findings were harmless. I simply looked through the prior medical records and in both cases found CAT scans from years ago that showed the exact same ‘abnormalities’. While I couldn’t offer a specific diagnosis, I knew that the findings were benign as the lesions had not changed.

If you are told that a radiology test is abnormal, make every effort to determine if a similar study was done in the past. Comparing the recent test with the previous one can be the cure you seek. These prior films may be in hospitals across town or in other states. These records can be hard to get, but the payoff can be enormous.

I advise patients to maintain a master file of their lab results, radiology reports and other medical records. Now you know why.

5 comments:

Drew said...

Well done.

Michael Kirsch, M.D. said...

Drew, welcome to the blog! I look forward, and expect, your erudite comments often.

Anonymous said...

Ive been taking painkillers (Lortab 5/500mg)acematiphen) to be precise for the past year and usually take about 6 pills in a 24 hr period. I recently weht to see my primary GP for some sleeping problems. Did some bllod work and results of elevated liver enzymes were present. From there I was ordered to get a CT scan of my abdominal region to see if there is anything abnormal going with my liver or any of my other guts. It's been three days and I still have yet to hear from my GP. Should I be concerned? I have been really worrying about possibly having liver damage of sorts due to the tyelonol in prescription narcotics. Can anyone advise me of what to do or possibly give me an ease of mind?? Pauly Z

Anonymous said...

I just got a call from my doctor's office saying my doctor wants me to come in "to discuss your CT scan results." Is there anything scarier? They will not tell me anything on the phone, so I am sitting here in knots. It could be anything. The only comfort I have is that the receptionist said, "The doctor did not put 'ASAP' on the note." Still, I am scared.

Michael Kirsch, M.D. said...

I agree that this would rattle any patient. If the results of a test are benign, we will advise the patient on the phone that the results are not serious but the doctor wishes to review them in more detail in the office.

As a patient, how would you suggest that we respond on the phone when the test results are serious? I'll offer my response after I hear your thoughts.

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