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.
As the health system shifts, radiologists will be expected to step out of the reading room and into patient dialogue more and more often.
Breast imagers are already at the forefront of patient-facing radiology, as direct patient contact has always been a foundation of breast imaging practices. Their experiences offer an example of how to enhance physician-patient interaction in everyday practice.
"Patient interaction gives meaning to what I do every day," says Debra L. Monticciolo, MD, FACR, vice chair for research and section chief of breast imaging at Baylor Scott & White Health in Temple, Texas. "Having a patient-centered focus drives us to quality, not only in interpretation but in total care to the patient."
Monticciolo, who also chairs the ACR Commission on Breast Imaging, starts with providing robust education for her staff. "Everyone from our schedulers to our technologists and nursing staff understands their role in our patients' care. This makes my time with patients more effective and more efficient," explains Monticciolo. Staff training focuses on situations likely to arise at each point of patient contact so that staff are equipped to respond appropriately. For example, phone schedulers are prepared to handle questions from breastfeeding patients or women who have had reconstructive surgery, while technologists are trained to educate patients about breast density. At weekly meetings, staff discuss scenarios from the previous week, and everyone learns from the feedback. "The more information and knowledge you share with your staff, the better off everyone is. It leads to a stronger team," says Monticciolo.
Allan S. Malmed, MD, chair of the radiology department and director of breast imaging at Northwest Community Hospital in Arlington Heights, Ill., agrees on the importance of well-trained staff. "Radiologists should rely on their mid-level staff to handle routine communications, to free up time for patients who urgently need to speak with them," he says. "This ensures radiologists still have the quiet, undistracted time they need to interpret studies."
Allowing reasonable time for examinations and building catch-up intervals into the schedule is also beneficial. For patients who require diagnostic follow-up, such as a breast biopsy, staff schedule appointments and explain the process and likely next steps, so that time is maximized once imagers meet with the patient.
"Communication with our patients was a commitment we made long ago as part of our efforts to provide the highest-quality patient care. And our practice has grown around it," says Mary Scott Soo, MD, FACR, associate professor of radiology in the breast imaging division at Duke University Medical Center in Durham, N.C. Soo suggests dedicating a private space to meet with patients. Have patients' reports and images available to discuss, and do not permit interruptions.
In Soo's practice, residents and fellows are taught communication skills as part of their training. "Understanding the patient's perspective not only builds compassion and enhances communication, it also helps radiologists anticipate questions and concerns and develop comfortable routines for discussions with patients," says Soo.
"Communicating directly with patients is not a task many radiologists are used to, but it is a skill that can be learned. Patients are nervous, and they are looking for any help that we can give them. With time and experience, you learn to ease patients' anxiety and reassure them in any way you can," Malmed adds. Monticciolo agrees: "If we can approach our patients with compassion and understanding, it really goes a long way, both for patients and for radiologists. It is very rewarding."
Reducing the wait time for screening mammogram results significantly cuts back on patient anxiety and enhances the radiologist-patient relationship. At Monticciolo's practice, radiologists worked with primary care providers to establish a protocol in which the breast imaging clinic can give results directly to patients. When a patient has an abnormal mammogram, by law a notification letter is sent, but the clinic also calls the patient. "We want to make sure the patient understands their next step and has the opportunity to ask questions," says Monticciolo. Patients who need further diagnostic testing can often be scheduled the same day or soon thereafter. This benefit could be extended to patients receiving all types of medical imaging.
At Northwest Community Hospital, women can request to wait on-site for their screening mammogram results. "Not every patient wants this service," Malmed explains. "But we have our systems set up so the radiologists have the dedicated, uninterrupted time they need to interpret mammograms, while still being available to provide results directly to patients." While these requests are not scheduled in advance, Malmed notes that usually the time needed is easily absorbed by the standard schedule.
The time required for a patient conversation is often unpredictable, but the benefits of making the effort are immeasurable. "It is very rewarding. It's really a privilege to help patients through often very emotional and vulnerable times," Soo says. "One relatively young, vibrant patient who required extra time and support during the biopsy recommendation told me she had decided to decline any therapy because of what she had seen friends and family experience during breast cancer treatment. We had a fairly long conversation, and I encouraged her to reconsider her decision. She later told me that based on our conversations, she changed her mind. This confirmed for me the importance of the radiologist's role at the time of diagnosis in providing compassion, support, and encouragement. We can empower patients to become involved in their healing as treatment begins."
And practices are seeing the benefits of boosting patient interaction. "We have patients who travel hundreds of miles, passing several large breast-imaging centers, to come to use because they know us and know we care," Monticciolo says. "That is a pretty big compliment."
Investing in patient communication puts a face on the radiologist as the patient's personal physician. This interaction adds value to the service provided, directly in line with emerging value-based payment models. "In order for radiologists to excel in the era of changing values and reimbursements," says Soo, "we need to establish a greater presence as personal physicians for our patients."
By Gene Bailey, freelance writer for the ACR Bulletin