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.”

Zars shared her story with RSNA 2015 attendees in a special RSNA-ACR joint session on patient-centered care. She was joined by radiologists Jennifer L. Kemp, MD, and James V. Rawson, MD, FACR, who shared their perspectives on changing the culture of medicine to be more patient centric. Both Rawson and Kemp recounted the moments that shifted their perspective and the way they practiced. Kemp experienced health care from the patient perspective when her husband was diagnosed with rectal cancer in his thirties, while Rawson had sick relatives throughout medical school and residency.

After Kemp’s glimpse of medicine as a patient caregiver, she realized she had a choice to make. “I could keep practicing medicine the way I was taught, the way I knew,” she said. “Or I could make a change.”

Here are steps you can take to make that same change in your practice.

Make your patients your partners. In the traditional model of care, patients are the recipients of care, almost passive subjects to which treatment is administered. It’s a paradigm shift for patients to be viewed as active partners in their care. “You actually aren’t the expert in their experience. They are,” says Rawson. “That means you’re going to have to listen.” The keys, according to Rawson, are partnership and collaboration.

“They made us believe that they truly are fighting this disease with us,” says Zars of her physician team. As her multiple specialists collaborated to support her and ensure that she understood what was happening, Zars and her family were able to focus on her recovery.

Relate to patients as people. “Where are the pictures?” asks Zars’ physician each time she goes in for a follow-up visit. He’s referring to snapshots of her growing family. This simple question reassures Zars that her doctor cares about her life outside her role as a patient. Zars encouraged physicians to get to know their patients, to understand how their condition impacts their lives, and to proactively work to instill them with confidence in their care.

Don’t exclude caregivers. Zars also recalls physicians asking her parents how they were coping with their daughter's diagnosis and their roles as caregivers. It helped, says Zars, that physicians “acknowledged that my support group was struggling as well.”

Mind your mannerisms. Patients take cues from their doctors about their prognosis and treatment. This includes what you say, of course, but also how you say it and what your body language communicates. Your patients remember if you shake their hand, if you look them in the eye, if you pause for questions. The way you conduct yourself is another way of showing your patients that you are invested in them and their care.

Remember the Golden Rule. Despite her extensive medical training, Kemp was surprised at how difficult it was to navigate the health system as her husband underwent treatment. “Medicine is a big scary maze, and radiology is a part of that maze,” she says. If she as a physician was having a hard time, she wondered, how do our patients do it? She began to approach patients with the proverbial Golden Rule in mind. What would you want if you or someone you love were the patient?

Have you been on the other side? Kemp asked the room. “If your answer is no, it will be yes one of these days,” she said.

Be a patient for a day. When Rawson’s hospital was revamping its breast center, the designer referred herself for a mammogram to get a real view of the center as a patient. And then she went back to the drawing board. She realized they had designed the center based on the concept that getting a mammogram was a bad experience and that all they could do was make it slightly better. Instead, the team worked to create a positive experience in which women felt relaxed and cared for. The result, says Rawson, is a spa-like center where patients tend to linger and recharge.

As she revisited the patient experience, Kemp chose to examine her practice’s paperwork. She found pages of patient questions that didn’t relate to the procedures being performed. The answers would not affect the way she managed the patients, she said, so why ask them?

Learn from others. You’re not the first to push for change in how medicine is practiced. You’ll find a wealth of resources around patient-centered care. The ACR Imaging 3.0TM initiative offers case studies from radiologists making change. Scroll through to get advice on a variety of projects and see what might work in your practice. RSNA’s Radiology Cares also offers a variety of resources for practices ready to partner with their patients. The JACR® publishes frequent articles on the patient experience. First-person patient narratives can also increase radiologists’ understanding of the patient perspective.

Build the patient perspective into your organization. “It’s a challenge to [shift thinking] as an individual. It’s a completely different challenge to do it as an organization,” says Rawson. Patients can be invited to join design teams, committees, and planning teams. Some health systems even involve patients in interviewing potential new hires. Rawson found that when patients are present in health system meetings, the tone shifts and discussion is forced to take into account the patient perspective.

“We have to remember who belongs in the centered of health care. And it isn’t us,” says Rawson. All participants acknowledged that changing our health system would be neither quick nor easy. “It’s a journey. We don’t get this done in a year,” said Rawson. “Start today, because in 10 years you’re going to wish you had.”

Are you seeing a shift in your health system? How are you making your practice more patient centered?

By Lyndsee Cordes, managing editor of the ACR Bulletin

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