The Customer is Always Sometimes Right

Providing quality care in an era of patient satisfaction surveys, Facebook likes, and online reviews

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June 2015

A recent study by radiologists at Massachusetts General Hospital (MGH) found a strong correlation between patient readmission rates and hospitals’ ratings on their Facebook pages.1

Researchers discovered that for every one-star increase on Facebook, there was a five-fold increase in the likelihood that the hospital would have a low readmission rate. No longer used solely to locate the best sandwich shop or vent about slow service, “social media ratings may influence patient perceptions of hospitals and potentially their health care choices,” note the authors of the study.

But the influence of these virtual ratings is only part of a deeper issue: How can physicians, especially radiologists, create a positive experience for their patients? And, perhaps more importantly, how can radiologists educate patients on appropriateness standards without earning negative reviews online or elsewhere?

A Sea Change

The relationship between radiologist and patient will likely undergo major changes in the near future given recent federal mandates, including Health and Human Services’ push to tie 90 percent of all fee-for-service payments to quality and cost measures by 2018. Now that HHS has given physicians an explicit deadline, radiologists will have to demonstrate their value to the health care team. And part of doing so will no doubt involve interfacing more often with patients, whether it be explaining findings on a point-of-care decision support tool or submitting reports to patient portals.

In line with this shift towards value, radiologists must contend with another changing dynamic: the rising importance of hospital patient-satisfaction surveys. As a recent USA Today article points out, annual incentive plans at many hospitals are increasingly tied to patient satisfaction.2 However, patient contentment is often based on perception as much as the objective value of the care received. For example, when it comes to imaging, patients may be grading their care based on whether they got the tests they wanted versus the tests they needed.

To avoid falling prey to perverse incentives that punish physicians for recommending the most appropriate imaging pathway, radiologists will have to explain their findings in a way their most important customers — patients — can understand. Although it may seem like primary care physicians have a more significant role to play as imaging gatekeepers, radiologists should not discount the importance of their role in ensuring patients receive the correct imaging studies.

A First Step

Radiologists interested in getting out ahead of these changes would do well to take a page from the radiology staff at MGH. The department has founded a radiology consultation clinic that allows patients to meet with radiologists to review images and ask questions. (Visit the Imaging 3.0™ case study, "Direct to Patients," to learn more to learn more.) At the clinic, MGH radiologists forge a personal connection with patients in a way that enhances the radiologists’ value to both patients and referring clinicians. Although the radiologists must volunteer their time for free when working in the clinic, and although the hospital is not compensated in any way for the consultations, the radiologists nonetheless see it as an important aspect of care.

“A radiologist’s time taken away from interpreting images remains a considerable barrier to routine patient consultations,” says Mark D. Mangano, MD, chief resident in diagnostic radiology at MGH and Harvard Medical School. “Our group has addressed this manpower issue by creating a radiology resident rotation where interested residents staff the diagnostic radiology consultation clinic with oversight from faculty members.” Although this approach may not be feasible for many practices, says Mangano, “there may be other creative, institution-specific solutions that allow radiologists to interface with patients.”
Mangano notes that one viable solution to the problem of reimbursement might entail levying an out-of-pocket fee to patients in a concierge setting. However, he adds, “as health care delivery and payment models continue to evolve, it’s possible that radiology consultations could fall into an unforeseen reimbursement bucket, such as payments for patient-centered care.”

"Patients appreciate openness and honesty. They want to know their options; what they don't want is to be tlked to like you'd talk to another doctor." — Alan Balch, PhD

For those groups with an eye to the future, some experts recommend training radiologists to think of themselves not just as image interpreters, but as ambassadors for medicine. “Most radiologists seldom see patients,” states Hector Ferral, MD, senior clinical educator at North Shore University Health System in Chicago. “They are so busy reading all the films produced in a day that it can almost feel unreasonable to ask them to attend a clinic.” However, he continues, if radiologists transform into consultants, they will have an opportunity to deal more directly with patients. “If a radiology imaging group pursues a radiology consultation model, they will have to have an ambassador for each one of the … most common areas that generate a consult, such as body imaging, neuroimaging, mammography, and nuclear medicine,” he says.

A Lingua Franca

However a group or department decides to interface with patients, physicians must communicate to patients the appropriateness (or inappropriateness) of exams.
According to patient advocates, it’s best to speak to patients as you would to a close relative. “Pretend you are talking to either your mother or your child,” says Nick Dawson, patient advocate, president of the Society for Participatory Medicine, and executive director of the Sibley Innovation Hub at Sibley Memorial Hospital in Washington, D.C.

Another key to communicating with patients is conveying empathy. One of the most effective ways to show sensitivity to a patient is through the choice of language. By way of example, Dawson notes that when his mother calls to ask a question about her computer, he knows he must display empathy if he hopes to get his message across. Instead of deploying a lot of technical language, says Dawson, he must meet his mother at the level of her understanding. “I know I have to use analogies that make sense to her,” Dawson explains. It also helps, he says, for radiologists to set aside everything they know about a subject and try to see it with fresh eyes, something Buddhists call “beginner’s mind.” “That doesn’t mean using a childish voice or tone,” notes Dawson. “It does mean taking time to think about terms and language.”

Alan Balch, PhD, CEO of the Patient Advocate Foundation, an organization that supports patients who are experiencing barriers in accessing care, agrees. “Patients appreciate openness and honesty,” says Balch. “They want to know their options; what they don’t want is to be talked to like you’d talk to another doctor.” Balch suggests that speaking in medical jargon sends the wrong signal: “The message the patient receives when you talk in terms they cannot relate to is, ‘I am the expert and you are not equipped to make a decision about your own care.’” He adds, “Your patient already knows that you have expertise they lack; what they are looking for is a sense of caring and mutual respect.”

Striking that balance between accuracy and elucidation is challenging, however. Robert K. Kerlan Jr., MD, professor of clinical radiology and surgery and chief of interventional radiology at the University of California San Francisco, advocates for being specific rather than vague when dealing with patients. “State where the findings are definite and point out the findings that are inconclusive, but give a concise summary at the end,” recommends Kerlan. In addition, he says, before parting company, radiologists should make sure to inquire whether all of the patient’s questions have been answered. “A simple inquiry as to whether or not the patient understands why an examination is being performed … can go a long way in establishing trust and confidence,” notes Kerlan.

In a value-based world, putting the patient at the center of care is paramount. And there is no better way to connect with patients than to interact with them directly. Not only is doing so a sure way to solidify the radiologist’s importance in the spectrum of a patient’s care, but it is the right thing to do.

By Chris Hobson, Imaging 3.0 content manager
1. Massachusetts General Hospital. Journal of General Internal Medicine. Hospital ratings on social media appear to reflect quality of care. Glover M, Choy G, Khalilzadeh O, Prabhakar A, Pandharipande P, Gazelle S. Published online March 7, 2015. Accessed March 17, 2015.
2. Pho K. Be wary of doctor-rating sites: Column. USA Today. Sept. 14, 2014. Available at Accessed March 19, 2015.

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