ACR Bulletin Feature Article

  • To Whom It May Concern

    As more patients gain access to their imaging reports, radiologists need to include more meaningful information to embrace this changing audience.

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ACR Bulletin Top Stories

Join the Narrative

Exchanging stories with your patients can transform your practice.July narrative

If ever there was an appropriate cliché in medicine, it's that there are two sides to every story. In radiology, your story can help connect you with your patients.

This connection can give rise to a more altruistic perspective and change how your patients see you as a medical professional. Engaging more closely with patients also ensures your place in an evolving, value-based landscape in which payment is tied to patient satisfaction.

All radiologists can share a memorable case, behind which is a story of a patient and a family whose lives have changed by how they were treated and the course of care they were set upon. For many radiologists, what they take away from a patient experience will ultimately drive their practice and become tangible in the treatment they provide.

Some experiences can shape how you view your job and instill a deep sense of empathy. One such experience, recalls Jennifer L. Kemp, MD, FACR, a private practice radiologist with Diversified Radiology of Colorado, was when her husband was diagnosed with rectal cancer. "I had been reading CT scans on cancer patients day in and day out," she recalls. "When we got the news about my husband, I thought I had a pretty good handle on how to deal with how our lives were about to change. But I didn't."

Fear and Answers

Kemp says the cancer diagnosis and ensuing treatment was horrible. "I had no idea about the fear around imaging and waiting for results. It was torture for my husband, who was otherwise in good health and only 37," she says. "I couldn't image how it would have been for patients with chronic conditions or advanced age."

As she and her husband navigated the health system, Kemp realized how unwelcoming health care can be. "And radiology is a big part of that problem," Kemp says. Keeping patients' feelings — their fears and frustrations — in mind during all stages of testing, diagnosis, and treatment should be paramount for all radiologists, she says. Her experience with her husband has resulted in changes to the way she practices. "I'm much more careful about the wording of my reports now," she says. "I'm also very aware that patients are waiting for results. So if I have a follow-up cancer CT for example, it's not going to the bottom of my pile."

Experimenting with small adjustments has made a big difference in Kemp's work. "One of the things my colleagues and I do is to put our phone numbers at the bottom of our reports." Now, she says, not only do other doctors call to exchange information, but patients call too. "I get a few calls each week. I don't feel inundated at all and it's extremely rewarding."

Meaningful Exchanges

Communication is key to understanding and connecting with your patients. Start small and do what you can, Kemp says. After the positive experience of addressing patients' questions and concerns by phone, she and some of her colleagues decided to add their email addresses to their reports as well. Breaking down communication barriers between patients and doctors can rewrite the script for everyone. "Sometimes I'll get a call from a patient asking me to look at their scan again," Kemp says. "They may tell me about specific areas where they are having pain or symptoms, and I might come up with an entirely different diagnosis because of that."

Talking to patients face-to-face can prove even more valuable, says Ella A. Kazerooni, MD, FACR, director of cardiothoracic radiology at the University of Michigan. "We should be prepared to talk to our patients," she says. "Outside of things like doing biopsies and other interventional procedures, our role with patients has been narrow. We work in an almost video game-like environment, where we sit in a room with a list of cases and images and our task is to clear that list as fast as possible." Those work habits, Kazerooni says, can obscure the patients behind the images. "When you train and practice in those environments you can sometimes become uncomfortable communicating with people. Your people skills might atrophy." Getting out of the reading room can put you on the right track to a much-needed conversation.

"Talk to the patients," Kazerooni says, "even when the findings are equivocal." You can tell them what the next steps may be and what their options are, she says. "Radiologists need to be a part of the communication chain between the patient and referring physician. Let them know you're actually a doctor."join the narrative in text

Story Elements

For radiologists, bettering a patient's care can take many forms. It could be making sure patients understand the procedure they are undergoing and providing appropriate contacts for answering questions (see sidebar). It could mean being prepared to answer patient questions yourself or simply asking, "Is there anything I can help you with?"

"When talking to patients you might hear things like 'Why do I have to drink this contrast?' or 'When am I going to get my test results?'" says Kazerooni. "That's a great opportunity to explain how the procedure will work or tell them about your patient portal for receiving results." You can share more about your practice via social media platforms, like Twitter or Facebook, showing patients another side of the professionals who provide their care. You may want to look into the patient experience at your facility when it comes to things like the waiting room amenities or the parking situation.

At Kazerooni's hospital, the nuclear medicine area is farthest away from the main entrance. "Our patients had to walk a really long distance to get to the PET/CT area. These are patients with cancer or heart disease, and they don't feel well or may be in a wheelchair," she says. Not only would some patients be exhausted by the time they reached the testing area, she says, but because of their poor muscle conditioning the patients consume a lot of the tracer (an IV-administered radioactive drug) used for the tests, which impacted the quality of the scan. When she and her staff discovered what was happening, they spoke with the parking employees and arranged for all such patients to park in a closer lot. "We alleviated what was a stressful issue for patients and a diagnostic quality issue for our technologists," says Kazerooni.

The challenges your patients face won't always be clear. Sometimes you have to ask. Occasionally they are wrapped up in a nice package for the opening. "A cancer patient left behind a spiral notebook in the waiting area one day," Kazerooni recalls. In an attempt to find the name of the owner, staff skimmed a few pages. "No one knew who the person was, but he or she had written down how they were feeling that day," she says. They decided to leave the notebook in the cubicle changing area and more and more patients started leaving notes. After seeing the response, staff decided to try something. They bought new notebooks, added an introductory message inviting patients to share their thoughts, and placed several in various waiting areas.

"Sure enough, patients started to write," Kazerooni says. "They write that they are nervous. They add to what others have said." The stories help connect patients to one another, they give radiologists and staff a glimpse into the patients' experience, and they offer patients an opportunity to express their feelings during what can be a vulnerable moment. "It's very touching," says Kazerooni. "The entries contain quite a wide range of human reactions."

Learning Breaks

This kind of information is found outside of the reading room and only furthers your efforts toward value-based patient care. "Working with patients in many capacities has taught me the value of their input," says James Rawson, MD, FACR. "As a medical student, I learned from patients as I took clinical histories and made diagnoses. As chair of a radiology department, I have included patients in the design of MRI scanners and mammography suites."

"It's good for you," says Kazerooni. Patient interaction can be a needed break from a labor-intensive focus and sometimes tedious work. "You'll take a coffee break anyway, so walk through the waiting room and introduce yourself to your patients," says Kazerooni. What you hear from them might be surprising.

In an age of radiology burnout, connecting with patients may also amount to self-preservation, Kemp says. "We sit and churn out the interpretations, working as fast as we can," she says. "Any little things we can do to make the patient experience better will contribute to our experience and satisfaction as physicians."

Everyone has a story someone else needs to hear. Kemp's story, in part, was the effect her husband's illness (and eventual recovery) had on her identity as a radiologist and the small things she could do to make her patients' lives better. For Kazerooni, her patients' notes provided a window into the people behind the images she reads each day.

"By the nature of being physicians, we ask questions," Kazerooni says. "We need to remember there are people behind those questions, and that they don't just need good medicine, but also good care."


For more ideas and guidance on improving referring physician relationships and communication with patients, access the Most Valuable Practice Guide bit.ly/ACR_MVP.


By Chad Hudnall, ACR Press managing editor

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