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Samantha Siegel: The Pitfalls of Complete Transparency

Samantha Siegel/LinkedIn

Jan 24, 2025, 17:22

Samantha Siegel: The Pitfalls of Complete Transparency

Samantha Siegel, Director of Cancer Survivorship at The Permanente Medical Group, shared a post on LinkedIn:

“The Pitfalls of Complete Transparency.

I went into medicine to ease suffering. However, one of the most painful aspects I’ve come to understand in clinical practice is that even when we show up trying to help, we can hurt people. Sometimes, it’s a systems level issue and it doesn’t matter if a provider is clinically excellent or compassionate.

Recently, I’ve encountered this issue in my onco-primary practice. Transparency laws have changed in the last few years such that scans and test results are automatically released to patients. Overall, this is probably a good thing. However, in some cases it’s not.

I personally learned of my own lymphoma relapse while staring at confusing PET scan results through bleary, tear-soaked eyes, trying to make sense of it all. My conversation with the doctor came later and I understand! She had a busy day with patients and the radiology report was published quickly, without knowledge or coordination with her schedule.

That’s just how it works right now. I was devastated. I cannot recall the exact timeline from seeing my scan results to having that follow-up conversation with the oncologist, but it may as well have been years.

This regularly happens to my patients. Scans are released and but for a few notable exceptions (pathology reports or CT/MRI scans showing a probable new cancer,) patients often get the results before we can get to them. They’re understandably upset. Sometimes our shared trust has even been injured and yet it’s nearly impossible to intercept the results for every patient, every single time.

Clinicians need slight delays for review, interpretation and even discussion with colleagues in other specialties. Patients just need the pain to stop and to know that someone is thinking about next steps and making arrangements. I’ve been on both sides of this, and yet it hasn’t gotten any easier. Simply knowing about and anticipating this issue is not enough.

As overall scan quality continues to improve, and we find more incidentals requiring follow-up, beyond the original intention for the scan, clinicians need time to review and to construct a detailed plan. This is fully evident in a complex care needs population such as an onco-primary panel as well as other specialities.

Maybe AI is one solution (for example, we can time the scan release date to a matched care coordination visit.) Maybe it’s giving clinicians the proper time to manage complex care needs populations. Maybe it’s advanced practice practitioners and a focused, teams-based approach.

I can tell you that the answer is not expecting people to just be more patient. Once that email comes notifying you of a scan result (which may determine the foreseeable future,) it’s pretty impossible not to look. (SCANXIETY) The answer is also not expecting clinicians to work around the clock. People have lives and we want our healthcare providers, well, healthy.

How has your system addressed this issue? Ideas welcome!”

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