A Doctor's Dilemma

Should we treat patients like our family — or treat our family like patients?

Treat each patient as if they are your family. We hear this wisdom taught in medical school classrooms, whispered in ward corridors, and echoed in our own heads.

Why Do You Ask?

Collecting accurate and actionable data starts with a patient-centric strategy.

Patient surveys aren't new, take precious time, and may not always reveal actionable results.

From Small Talk to Real Connection

A conversation between strangers takes one cancer survivor on a journey of advocacy.

To Whom It May Concern

With growing numbers of patients accessing their radiology reports, it matters more than ever what you say — and how you say it.

Radiologists have long written reports with other physicians in mind. But as more patients gain access to their imaging reports, radiologists need to embrace this changing audience and create a new kind of impression.

Join the Narrative

Exchanging stories with your patients can transform your practice.

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.

What You Mean to Population Health

How will shifting health care models affect radiology's role in patient care?

Fifteen years ago, population health was a "relatively new term, not yet precisely defined." Today, population health — and more specifically population health management — is on most medical specialists' minds, even if they aren't sure exactly how it will affect their practices and their patients.

Radiologists and Internet Transparency: You Can Run but You Cannot Hide

Do you know what your patients are posting about you? It's time to look.

Locked away in dark reading rooms, insulated from patients and referring physicians, radiologists can nearly double their RVU production — and that translates into a hefty income differential. Working in isolation, it might seem, can be quite lucrative.

Final Read

How do you define value in your daily practice?

Value, quality, cost: these are somewhat amorphous terms trumpeted routinely in the context of the recently passed Medicare Access and CHIP Reauthorization Act.

Primer on Patient and Family Centered Care

Radiology is changing and not in the way you may think. Advances in imaging technology have always shaped our chosen profession and will continue to do so throughout our training and during our future practice. But it is not a new technology or imaging modality that is bringing change to radiology. Rather, it is a concept that is not new at all: patient- and family-centered care (PFCC).

Final Read

Sara H. Kim, MD

Q: How do you create the ideal patient experience in your practice?

Every day, as a radiation oncologist, I witness the stress patients living with a cancer diagnosis go through.

Patient Experience and Payment Policy: One and the Same

The Commission on Economics is committed to ensuring opportunities for radiologists contribute to an improved patient experience.

Continually improving patient experience is what we strive for; it is the right thing to do. But if that were not motivation enough, policymakers have made patient experience an integral component of radiology payment policy.

The Road Less Traveled

Find a path to patient-centered radiology by following in the footsteps of Imaging 3.0® leaders.

Robert Frost, one of America's most-celebrated poets, once said, "Two roads diverged in a wood and I – I took the one less traveled by, and that has made all the difference."

Seeing From the Other Side

Thinking about incorporating the patient perspective into your practice decision-making? Here's how to get started.

Hospital X was a newly remodeled facility advertised as the height of patient care.

Moving Forward

Technology can be a powerful tool as the patient role changes.

With the shifting atmosphere of value-based health and the ever-present development of new technologies, physicians are inundated with change. But health care is changing just as much, if not more, for patients as well.

Out of the Dark

The Johns Hopkins Radiology Resident Consult Service

Advancements in imaging technology in the last several decades have ushered in a new golden age of radiology. The development of PACS, new imaging modalities, and new protocols and techniques has greatly improved our ability to serve our patients and our referring providers.

Stage 1

When Barbara received her breast cancer diagnosis, she joined two of her aunts in fighting the disease.

My family has a history of breast cancer. Two aunts on my mother's side battled the disease.

Reducing Anxiety, One Patient at A Time

Can radiologists help their patients feel more comfortable with screening procedures? According to a recent study published in the JACR, the answer is yes.

Leading the Way in Patient Interaction

What can breast imagers share with the specialty when it comes to patient communication?

Communication is a fundamental part of the human experience. Any average day is filled with countless moments of personal interaction, from exchanging a simple "good morning" with a colleague to dictating a case to starting a dialogue to resolve a problem. Yet finding a moment to speak directly with a patient can be challenge for many radiologists.

A Human Touch

Putting a face on radiology, one encounter at a time.

Sometimes the brightest results come out of the darkest times. A cancer diagnosis can drive anyone to despair.

Final Read

Join Y. Luh, MD

Q: How do you include patients in their health care decision-making?

As a radiation oncologist, I have direct face-to-face interaction with patients throughout the care process, from the initial consultation to long-term follow up. These interactions ensure I cultivate lasting relationships with cancer survivors.

Conversations from ACR 2016

Raymond Tu, MD discusses Patient Engagement

Three Things to Read Today

Intriguing Links from Around the Web

This week, we’re reading about burnout in radiology, the unrecorded amount of time patients spend managing care, and obstacles women face in medical school.

Patient Interaction Revamped

Residents at Indiana University School of Medicine get out of the reading room to deliver patient results in person.

"If someone would have just come in here and told me my ultrasound was negative, I would have doubted them or not believed them. To go through the images and have everything explained shows me that the test is truly normal and there is someone dedicated to looking at every image." — Ms. C (a patient who participated in a radiologist consultation)

The Moreton Lecture: Stepping Out of the Dark Into the Light

Radiologists must not let others tell their stories.

Moreton lecturer and patient advocate Andy DeLaO (@cancergeek) opened his talk by reminding radiologists why they were in the imaging profession. “Revenue and payment are the results of what you do, but the purpose, cause, and belief that you find in your work — that’s why you do it,” said DeLaO.

Economics Forum: The Economy of Care

Patient-centered care was front and center at this year's economic forum.

Part two of Monday’s Economics Forum began with an awards ceremony. William T. Thorwarth Jr., MD, FACR, ACR’s chief executive officer, presented the Thorwarth Award for excellence in economic and health policy to Christopher G. Ullrich, MD, FACR. Thorwarth called Ullrich a “tremendous contributor” to the area of economic policy and to the specialty.

3 Things to Read Today

Intriguing Links from Around the Web

This week, we’re reading about facilitating communication with team members, asking the right questions, and more.

A Combined Approach

Radiologists are working with their colleagues to improve the patient experience through initiatives big and small.

When her husband, Nick, was diagnosed with stage 3 rectal cancer in 2004, Jennifer L. Kemp, MD, FACR, diagnostic radiologist and body imaging subspecialist at Diversified Radiology in Denver, thought she knew what to expect. By then Kemp had been a private practice radiologist for seven years, experience she thought would make navigating her husband’s care — including surgery, chemotherapy, radiation, and imaging — seem like second nature.

3 Things to Read Today

Intriguing Links From Around the Web

This week, we’re checking out social media tips, learning about collaboration, and reading about the overall benefits of taking your time with patients.

3 Things to Read Today

Intriguing links from around the web

This week we’re reading about ways to make using big data effectively, what doctors are really searching for, and the importance of patient empathy.

Walking the Walk

The newest ACR commission is setting out to revolutionize patient care. In the inaugural meeting in Augusta, GA, members got a crash course in what the future of health care might look like.

“The way you have to teach patient- and family-centered care is by bringing the patient into the room.”

— Pat Sodomka, pioneer of patient-centered care

Traveling Toward Patient-Centered Care

The Commission on Patient- and Family- Centered Care convened to lay the first steps in value-based care.

On February 12, 2016, thought leaders from across the country met for the inaugural meeting of the American College of Radiology’s (ACR) new Commission on Patient and Family Centered Care (PFCC).

3 Things to Read Today

Intriguing links from around the web

This week we’re reading about how to stop a nuclear meltdown (and how that relates to radiology) and finding time to connect with patients.

Getting the Word Out

With health care becoming increasingly consumer driven, how do you market your practice to both patients and referring clinicians?

The tiny town of Lovettsville, Va., boasts a population of 1,801 — only one of whom is a general practitioner. Because of the town’s size, campaigns for preventative health practices such as mammography were scarce. Until, that is, one of the residents was diagnosed with breast cancer.

A Simple Connection

To foster patient engagement, radiologists should put their contact information in their imaging reports.

As health care moves toward quality, radiologists are looking for ways to provide added value and engage patients. While some practices have instituted consultation services and other programs that give radiologists face time with patients, many groups don’t have the resources for such initiatives. And that’s okay.

(Slightly Belated) New Year’s Resolutions

What will you do this year to become a better radiologist?

Although January is usually the time for New Year’s resolutions, I decided to wait until February before discussing them. I wanted to give everyone time get moving on goals to lose weight, eat heathier, exercise more, or learn a new language. These are all noble resolutions, but they only relate to our personal lives. How many times do we make resolutions about our professional life? I’m not sure I have ever done it.

Keeping Patients at the Forefront

As the health system shifts, radiologists must stay in tune with the needs of their patients.

As I write, open enrollment season is closing and many of our patients are selecting their health insurance plans for 2016. Five years after the signing of the Affordable Care Act, we have seen the number of uninsured Americans drop significantly. There have been, however, concurrent significant changes in the design of health care benefit plans.

Designed for Imaging

Practices have a lot to consider when designing a new facility or renovating an existing imaging center.

When Radiology Imaging Associates, a private practice with offices in Maryland and Virginia, began designing a new imaging center next to a daycare in 2005, safety was of the utmost importance.

Boots on the Ground

Taking Imaging 3.0™ from the front lines of the battlefield to your practice.

January 2016

Imagine waking up to go to your practice on a Monday morning — it’s only a 10-minute walk away. The scent of mud and sewage hits your nose, and the air is filled with the sound of construction and other industrial noises. Sirens wail in the distance. You quickly sidestep the potholes that litter the ground as you enter your department, a series of beige walls meant for quick deconstruction should the need arise. Your patients often arrive by helicopter, and the minute you enter, work begins.

Welcome to being a combat radiologist. Welcome to Afghanistan.

Who’s in the Center of Your System?

Changing our practices one patient at a time

December 2015

Being diagnosed with brain cancer is disorienting for any patient. When Christine Zars, MS, found out she had a brain tumor at age 19, even the term “tumor” was confusing. “’Tumor’ meant absolutely nothing to me,” she said in a joint RSNA-ACR session, “but I could tell from my parents’ reaction that this was really bad.”

A Case for Open Patient Records

After a voluntary MRI reveals an abnormality in his brain, one MIT grad student becomes an advocate for open medical records — a critical element to engaging patients as partners in care.

November 2015

When Steven Keating walked on stage carrying a 3D-printed model of his skull and brain tumor, everyone was eager to hear what the advocate for open-sourced medical records had to say.

Informatics Meets Patient Care

A new video series traces the patient experience and aligns informatics tools along each step of the way.

October 2015

John is somewhere over the Midwest, trying to read an inane magazine from his seatback pocket, when his head begins to spin and he’s hit with a wave of fatigue. But by the time the plane lands, John is experiencing chest pain, calf swelling, and a high heart rate. He hasn’t officially finished his trip and he is headed to the nearest emergency department.

Making History

Breast cancer’s history is rife with empowered patients willing to fight for the cause. How can breast imagers continue that effort?

October 2015

Breast cancer awareness is everywhere. Once October hits, the varied pinks of breast cancer awareness ribbons and products are just as common as the red and oranges of falling leaves. It’s hard to believe that decades ago even mentioning breast cancer was frowned upon.

The Mammogram I Almost Missed

Chelsey Fischer decided to have a mammogram despite the USPSTF screening recommendations. Her choice saved her life.

October 2015

Every person has several pivotal moments in their life, ones that you look back on and judge your life before and after.

3 Things to Read Today

Intriguing Links from Around the Web

September 2015
This week, we’re reading about physician perceptions of care, the value of patient interaction, and how you can be prepared to be a physician at any minute.

Getting Specific About Patient-Centered Care

The chair of ACR’s newest commission looks at where radiology fits into value-based health care.

November 2015

For my column this month, I spoke with James V. Rawson, MD, FACR, about his latest role at the ACR, as chair of the brand new Commission on Patient Experience. I’ve worked with Jim for several years in his role as chair of our Committee on the Hospital Outpatient Prospective Payment System (HOPPS) and treasure him as a colleague and friend.

Informatics Meets Patient Care

A new video series traces the patient experience and aligns informatics tools along each step of the way.

October 2015

John is somewhere over the Midwest, trying to read an inane magazine from his seatback pocket, when his head begins to spin and he’s hit with a wave of fatigue. But by the time the plane lands, John is experiencing chest pain, calf swelling, and a high heart rate. He hasn’t officially finished his trip and he is headed to the nearest emergency department.

3 Things to Read Today

Intriguing Links from Around the Web

September 2015

This week, we’re measuring the doctor-patient relationship, revealing invisible colleagues, and more.

Allied Practice

Making your practice safe for transgender patients requires subtle yet vital considerations.

In 2011, the National Center for Transgender Equality and the National Gay and Lesbian Taskforce published a report analyzing the current state of discrimination against transgender individuals in the United States. They found that 25 percent of the surveyed group of transgender people experienced some form of harassment in a medical setting.

Redesigning Patient Communication

Updates to RadiologyInfo.org make the site and content more user-friendly.

September 2015

For 15 years, RadiologyInfo.org has been bringing information to the public about a wide range of radiology exams. The collaborative effort between RSNA and the ACR recently underwent a major redesign with two goals in mind: to offer seamless access on a variety of devices and to convey the information in a way that would be easier for the general public to digest.

We Started a Radiology Consultation Clinic

One institution shares its experience offering patient consultations with radiology residents.

August 2015

At Massachusetts General Hospital (MGH), radiology residents are on the frontlines of patient care, rounding with primary care physicians to speak with patients about imaging results. Colin M. Segovis, MD, PhD, RFS secretary, talked with Mark D. Mangano, MD, chief resident in radiology at MGH, to get the scoop on how the clinic came about and which metrics radiologists are collecting to demonstrate the clinic’s value.

3 Things to Read Today

Intriguing Links From Around the Web

August 2015

This week we have how one radiologist's battle wth cancer has helped her connect with patients, ways you can make an impact as a leader, and what patients are looking for from hospitals.

Empowering Patients

As patient interaction increases, how can radiologists improve communication to ensure appropriate care and maximize value?

August 2015

As you may have noticed in your practice, patients today increasingly expect to understand and make decisions about the health care they are receiving.

Introducing the ACR Commission on Patient Experience

A newly formed group helps radiologists put our patients in the center.

August 2015

Now more than ever, radiologists look to the ACR to lead the way in a changing health care system. One of the most exciting areas of change is the push to understand and improve the patient experience. I’m pleased to announce an important step in supporting radiologists as they provide patient-centered imaging care: the ACR Commission on Patient Experience.

Introducing the August Special Stakeholder Issue

Learn how to connect and add value for various stakeholders with tips from stakeholder leaders.

August 2015

"It's hard to place the patient at the center of health care if you're standing there yourself." - James V. Rawson, MD, FACR

3 Things to Read Today

Intriguing Links from Around the Web

July 2015

This week we’re reading about how radiologists can do more with less, why imagers should be circumspect when it comes to using GBCAs for MRIs, and the patient perspective from John Steinbeck.

Final Read

Evelyn Y. Anthony, MD

July 2015

Q: How do you make interacting with patients a priority?

 As a Pediatric radiologist, I probably have more opportunities to connect with patients than many radiologists. One of my most memorable experiences was about two years ago.

Making a Difference

One New York City radiologist bucks convention to establish a patient rounding program at her hospital.

July 2015

If something sounds too good to be true, it probably is. We understand instinctively that all that glitters is not gold. Roundtrip airfare to Paris for just $150? Sure. A subscription to Wired for the one-time low cost of ten cents per month? We start looking for the strings.

A Different Ending to the Story of Lung Cancer

For Dan Kitts, early screening might have changed everything. His diagnosis sent Andrea, Dan’s wife, on a quest to bring life-saving screening to patients at risk.

June 2015

One of the sad facts about lung cancer is that, because of the ferocity of the disease, it’s a challenge to obtain a perspective from patients themselves. So many die before telling their stories, leaving their loved ones to take up the cause. At 10:21 a.m. on April 12, 2013, my soulmate, Dan, joined the almost 160,000 annual victims of lung cancer. The saddest fact is his story did not have to end this way.

The Customer is Always Sometimes Right

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

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

3 Things to Read Today

Intriguing links from around the web

This week in links we have the pros and cons of image sharing, how to engage with your patients, and the USPSTF’s updated breast screening recommendations.

Meeting in the Middle

How can radiologists make their practice more patient-centered?

April 2015 

Given Health and Human Services’ recent push to tie 90 percent of all fee-for-service payments to quality and cost measures by 2018, the relationship between radiologist and patient is set to undergo major changes.

Seeing Eye to Eye

Determining the definition value may require stepping out of your comfort zone.

 April 2015

In health care, we've been talking about value ad nauseam. That's how physicians are starting to get paid.

The Vision to Heal

The SIR's vision of innovation, collaboration, and patient-driven care highlights the value of interventional radiology to our practices.

April 2015

Those who attended the 2015 Society of Interventional Radiology (SIR) Annual Meeting were introduced to The Vision to Heal, a new brand and vision for the society and the clinical practice of interventional radiology (IR).

Final Read

Lynn S. Broderick, MD, FACR

March 2015

Q:What is one of your most memorable experiences with a patient?

Years ago, I performed a venogram on a middle-aged woman.

Final Read

Taj Kattapuram, MD

February 2015

Q: How has social media helped your practice?

 Social media is a wonderful educational and interactive tool for the department of radiology at Massachusetts General Hospital.

The Difficult Patient

Defusing challenging patient encounters requires the right balance of sensitivity and assertion.

It was late at night when a mother took her child to Boston Children’s Hospital (BCH) with severe abdominal pain and abnormal stool. An ultrasound revealed that the child was suffering from an ileo-colonic intussusception and needed an emergency air enema.

Final Read

Q: What is the one thing you wish your patients knew?

I wish they knew that, as radiologists, most of what we see we recognize and know well, but we don’t always have the right answer. That’s just the nature of the beast.

Mapping Out Success

Survivorship plans are a critical tool for patient care, yet they are not always implemented.

Imagine that you've just landed in a foreign country. Problematically, you don't speak the language, you don't know how to get to your hotel, and you don't know any of the social customs. Dead ends seem to hit you everywhere, and you don't know whom to call for help.

Adopting a Patient Perspective

When Karin Charnoff-Katz, MD, was diagnosed with breast cancer, she entered the patient experience and left a changed physician

On my way to work as a general radiologist in Memphis, I detoured to stop for a routine screening mammogram. I was 41 and a few months late for my second annual screening.

One Specialty, Two Approaches

ACR and RSNA programs lead the way in patient-centered care.

We've heard the clarion call: Health care's new economics require all providers to transition from volume-based to value-based care. For radiologists, that means shifting our practice paradigm from transactional to consultative and focusing on both interpretation and outcomes.

Front and Center

Twitter-savvy radiologists use social media to uncover pro-patient solutions.

Providing valuable care to patients has always been a tenet of medicine. Because value means something different to everyone in health care — patient, doctor, and administrator — physicians must strive to create patient-based care that adheres to everyone's needs.

The Satisfied Patient

Beyond quality medical care, many factors influence a patient's decision to stay with a particular practice or seek treatment elsewhere.

Most people have had an experience at a restaurant that has deterred them from going back. Maybe the server wasn’t friendly and attentive, the restaurant wasn’t clean, or the wait time for a table was too long. Whatever the hitch, it may not have even involved the food itself.

Reaching Across

Spanning the doctor-patient divide with user-friendly patient portals.

In February of 2013, Dacia G. Hodgin, a patient at Wake Forest Baptist Medical Center in Winston-Salem, N.C., had a biopsy performed on her ear. Hodgin and her primary care physician didn’t expect the biopsy results to show anything too alarming. But the next day, Hodgin’s doctor called to inform her that the biopsy had revealed a rare form of cancer.

Patients and Partners

Engaging patients in their own care to create better outcomes and generate cost savings.

It’s old news that patients want the same type of information about health care that they expect from other major products and services.

Final Read

Q: Describe a signficiant interaction you had with a patient.

When generating diagnostic imaging interpretations, radiologists may use medical nomenclature that can confuse both referring physicians and patients. A simple, quick conversation goes a long way to resolve these misunderstandings.

Final Read

Andrew L. Rivard, MD

Q: How do you place yourself at the center of patient care?

Although it is impossible for me to meet every patient, I am able to interact with patients undergoing certain procedures.

An Incomplete Picture

As some electronic health records systems become harder to access, radiologists find it difficult to assemble patients' complete medical histories.

Imagine a time in which a few giants of industry rise up to consume the majority of market share. An era when small-scale businesses are run out of town because the major players will not engage with them operationally.

The Neighborhood Radiologist

Practices across the country are getting involved in their communities to connect with patients and spread the word about the role of the specialty in health care.

Earlier this month, radiologists, radiation oncologists, and medical physicists around the world turned their attention to showcasing their specialty on the International Day of Radiology.

Class Act

Radiologists get a lesson in conveying empathy to patients.

Imagine your 6-month-old patient's parents are anxiously waiting in the next room. Ultrasound images confirm a tumor in their son's liver. Now you must convey the bad news.

Recognition for Radiology

Top-quality radiology teams receive recognition for outstanding diagnostic imaging and patient care.

In this age of profound changes in health-care delivery models, radiologists must find new strategies for demonstrating their value and staying viable. A new addition to the Imaging 3.0™ toolkit is the ACR Diagnostic Imaging Center of Excellence™ (DICOE™) achievement.

Patient Engagement Goes Online

You've launched your patient portal. Now what?

In June, the Bulletin interviewed radiologists about their experiences implementing online patient portals. (Read about it at http://bit.ly/OnlinePortals.) But to satisfy meaningful use (MU) requirements, radiologists must do more than just launch a patient portal.

Imaging on the Road

Mobile imaging units are convenient for patients, but adding one to an existing practice is not a decision that should be made lightly.

Traditionally when patients need imaging services, they visit their local hospital or outpatient imaging center.

Bright Ideas

Practices are getting creative as they market their services in a changing health-care environment.

Things are changing in the world of health care. And as the health system shifts, so does the business climate.

Cutting Variation to Boost Patient Outcomes

Moreton Lecturer links robust protocols to better results.

The Monday morning council session at AMCLC 2013 wrapped up with the much-anticipated Moreton Lecture, given by Brent C. James, MD, Mstat, executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare in Salt Lake City. James presented the lecture "Value, Variation, and Patient-Centered Care: Building Radiology's Future."

Final Read

Q: How do you make interacting with patients a priority?

When most physicians applied to medical school, they stated during their interviews that they wanted to go into medicine to help patients.

Direct Access

Online portals give patients easy access to radiology reports.

When Diana Roberts Wienbroer, 71, of New York City, was diagnosed with breast cancer in 2000, she had a lot of work ahead of her.

Close Calls

Radiologists remember the cases they almost missed and the things they learned in the process.

It's an unfortunate truth that one of the best ways to learn is by making mistakes. Few things burn an idea into our minds the way a negative event can, especially one that we could have prevented.

Open Access

Maine launches the nation's first statewide image archive to improve patient care.

When it comes to sharing X-rays, ultrasounds, and other images, an information gap exists. With no widespread digital networks for sharing images, patients often bear the burden of obtaining and transporting their images from one provider to the next.

Getting the Word Out

"Nothing in life is to be feared. It is only to be understood. Now is the time to understand more, so that we may fear less." — Marie Curie

Fear of radiation has been around since the discovery of this game-changing process. And as Madame Curie knew, understanding is the key to overcoming that fear.

Great Expectations

Challenging ourselves to meet the service expectations of our patients.

I came across an opinion article in the New England Journal of Medicine that I thought had some valuable lessons for radiologists.

In the Patient's Shoes

Radiologists question — and evolve — the patient experience with input straight from the source.

Unfortunately, receiving a CT, MRI, or other imaging exam referral can sometimes instill a sense of dread in a patient.

Making Wise Choices

The ACR joins a campaign designed to question the necessity of common procedures.

The key ingredient needed to make a good choice is knowledge. For example, most radiologists know that routine imaging for low back pain is often overused.

Sharing Data Safely

The role of technology in productivity and patient safety explored at new ACR meeting.

The relationship between radiologists and technology is complicated. Strides in digital imaging technology enable radiologists to do more work in less time and provide more data that needs to be evaluated.

The Ripple Effect

ACR Clinical Research Center trials create waves of change in patient care.

For more than 40 years, the ACR has supported clinical research endeavors crucial to shaping medical imaging and radiation oncology.

The Right to Speak?

Experts weigh in on giving imaging results directly to patients.

Radiologists have traditionally served as the "strong, silent type" in the health-care arena. Although they are a critical bridge between the patient and the referring physician, their voices were often unheard or deemed unnecessary.