"Chasing a Ghost": Factors that Influence Primary Care Physicians to Follow Up on Incidental Imaging Findings

In Radiology, Hanna Zafar and colleagues, including Rosemary Frasso, explore factors that influence how primary care providers (PCPs) communicate and manage incidental imaging findings. Through semistructured interviews, researchers explored concerns and perspectives of 30 PCPs on receiving and acting on incidental imaging findings. Many providers expressed frustration stemming from the “quagmire” of follow-up for incidental findings producing a large financial burden on the health care system. Although these PCPs believed that the majority of incidental findings were of limited clinical importance, they felt compelled to perform follow-up for a variety of reasons, including low tolerance for ambiguity, lingering uncertainty, institutional or national culture, and fear prompted by outlier reports of malignancy in young patients. Other PCPs felt uncomfortable managing incidental imaging findings outside their experience or scope of practice; the challenges of researching the clinical importance of these findings or seeking specialist consultation led to inaction. Some PCPs reported using a uniform approach to communicate and manage incidental findings, while others adapted their approach to the patient and the finding. Sometimes PCP characteristics such as follow-up style superseded patient characteristics. At other times patient characteristics such as health literacy superseded PCP characteristics. These results suggest that some patients may receive inappropriate follow-up of incidental imaging findings, and present an opportunity for radiologists to improve the way PCPs and patients use the information conveyed in imaging reports.