Patient-Centered Care and the Radiologist
Empathy is the key.
Editor’s note: at RSNA 2017, Carestream will feature medical imaging and healthcare IT solutions that support the industry’s transition to Patient-Centered Care. To set the stage, we developed a three-part blog series on this timely topic. This is part two of the series. You may wish to read part one, “Understanding True Patient-Centered Care”, and part three, “Patient-Centered Care and the Technologist.”
“Patients want a personal relationship with their doctor, good communication, and above all, empathy.”1 – James Rickert, M.D., Orthopaedic Surgeon and Advocate for Patient-Centered Healthcare
Historically, most physicians, radiologists included, typically maintain a continual state of objectivity – because they believe that becoming close to their patients and acknowledging their emotions will detract from their ability to provide effective care.
Yet, if we accept the definition of patient-centered care established in the first blog post in this series as a philosophy in which everything revolves around the patient – with respect for each individual’s unique feelings, needs and preferences – then a doctor-patient relationship that’s exclusively clinical simply won’t suffice. Genuine patient-centered radiology requires genuine empathy – seeing and feeling the situation from the patient’s point of view.
This is achievable only through a strong human connection between the patient and physician. As Mark S. Lerner, RT, division director of radiological operations at George Washington University Hospital in Washington, D.C., says, “It’s impossible to be at all patient-centered without breaking out of the mold where patients are regarded as ‘the chest X-ray,’ or ‘the CT of the liver.’” 2
In other words, clinical detachment is not always positive.
This is brought to life vividly in the 1999 film “The Doctor.” William Hurt portrays an aloof, self-centered physician who is a luminary in his field – brilliant, objective, and lauded by his colleagues. But he is resented by his patients for his callous and indifferent attitude. When he becomes desperately sick himself with a malignant tumor in his throat, he’s shocked and appalled as he experiences firsthand the clinical insensitivity to his pain and fear.
The story does have a happy ending. The doctor recovers, and having walked a mile in his patients’ shoes, discovers the crucial role of empathy. He emerges as a far more sensitive, compassionate and effective practitioner.
Lessons for real-life radiology
This is also a lesson to learn in real life, according to Jennifer Kemp, MD, a private-practice body imager with Diversified Radiology of Colorado. Dr. Kemp’s approach to radiology changed dramatically when her husband was diagnosed with cancer. “Was I clueless? I probably was more naïve than most radiologists,” she said. “Being on the other side of medicine has helped me learn to be more empathetic.”3
Based on this experience, Dr. Kemp has some valuable advice for radiologists, as detailed in “Promoting Patient-Centered Care in Radiology,” a January 2017 post on the Physician’s Practice Blog. Among her recommendations are these – all of which begin with cultivating one’s sense of empathy:
- “While radiologists know all too well that the results of diagnostic imaging can sometimes be ambiguous, patients want a clear diagnosis of their condition. If that’s not possible, explain why as simply and straightforwardly as you can. In all cases, give them as much specific information as you can.
- Some radiology patients are understandably afraid of what their X-rays might reveal. This can make them angry, irrational or otherwise difficult. Try to bear in mind that their attitude is induced by their fear, and do your best not to take it personally. Remember too that anxiety can also actually affect outcomes – most are familiar with the phenomenon of ‘white-coat induced high blood pressure’.
- To help patients better manage their emotions, keep them abreast of what’s going on – even regarding small issues, like a delay at your facility that might push back their imaging exam. Don’t let them sit in the waiting room and worry.
- Patients are anxious to hear your explanation of what their exams showed. Take pains to be clear regarding your findings and what will happen next. Take a few extra minutes for a thorough conversation about their care.”4
These are all excellent points. Yet, as important as what you say is to your patients, listening to them is even more crucial. While it’s easy to assume that most physicians are doing just that, the research says otherwise. In an article published in The Annals of Internal Medicine, researcher Howard Beckman, M.D. found that in the 74 office visits he evaluated:
- Only 17 (23%) of patients were allowed to complete their openings statement of concerns.
- In 51 (69%) of the visits, the physician interrupted the patient’s statement and redirected the conversation.5
Dr. Beckman concludes that this failure to let patients describe their symptoms and concerns results in the loss of potentially valuable diagnostic information.
Seeing the light
Still, we’ve made substantial progress. It wasn’t long ago that only a small minority of patients had any type of direct contact with a radiologist whatsoever. Today that’s changing, as more and more radiologists embrace the Patient-Centered Care model and “come out of the dark” to interact with patients. As they do, it’s important for them to adopt specific strategies such as the following:
Optimize first impressions
When new patients are referred to you and visit your office for the first time, do all you can to make their initial impression a positive one. Consider coaching your receptionist to greet each one with a warm smile and eye contact. Ask them to give the patient their full attention, and offer a greeting that’s something like this: “Good morning, Mrs. Brown! Thanks for coming. We’re so glad you’ve come to us for your exam today – and we’ll be sure to take exceptional care of you.”
Right from the get-go, Mrs. Brown will feel valued and cared for. Of course, you’ll want to have your returning patients greeted with the same warmth and personal attention.
Get your entire staff on board
Everyone in your office, from receptionists to nurses to technologists, needs to become a true, empathetic patient-centric performer. You can give them instructions yourself, enroll them in formal training, or ideally, do both.
Take note, though, that the habits your people have developed over time could undermine your patient-centric goals. It might take vigilance and many reminders from you before the new behaviors take root. Perhaps the best tactic is to show them, in addition to telling them, what patient-centric care looks like. Give them consistent examples through your own behavior.
Respect and honor diversity
Over time, you’ll see all sorts of patients – different races and ethnicities, religions, ages, sexual orientations, disabilities and more. You’ll also encounter many kinds of family units – those married with children, same-gender couples, single-parent households and others. All have different values, concerns and areas of sensitivity. What they share in common, however, is the need and desire for respect. You need to empathize with all of these concerns.
With this in mind, consider spending some time reading up on the cultural attitudes and expectations of the various people who form your patient base – so you can communicate with them smoothly and appropriately. If you practice in a large organization with deeper resources, you may be able to draw on a translation service when seeing non-English speakers.
Take the time to care
Like most radiologists today, you’re under severe time pressure – you’re overbooked, stretched thin and often stressed to the max. But the very worst place to try and save time is in your conversations with patients. If they see that you’re rushing to finish with them and get on to the next patient, they won’t feel valued or cared about – and your patient-centric aspirations will go right out the window. So as much as possible, take your time explaining their exam results, and give them the time to ask their questions and express their concerns. You can also ask them to play back the information you’ve given them. That way, you can be confident you’ve made yourself clear.
Put patients on your healthcare team
More and more, patients want to be active participants in their own care, rather than passive beneficiaries. If you put yourself in their place, this is easy to understand – who wouldn’t want to have a say when it comes to their own health? The first way to get them involved is through that all-important skill of listening as they describe their situations and their symptoms. Don’t jump to any diagnostic opinions until you’ve heard them out. This will make them feel like part of the team, and provides you with valuable diagnostic information.
Another key is to introduce your patients to image-sharing technology. Carestream’s MyVue, for example, is a patient portal that allows patients to view their images and exam reposts online – easily and securely. They can share images with family, and forward them to other practitioners or healthcare facilities.
You can also include patients on committees and planning initiatives for improving the quality of care, remodeling your facility to be more patient friendly, and so on.
Don’t forget them after they leave
Be sure to have your office follow-up with the patient by phone or email after their appointment. Ask them how they’re feeling, if their situation is improving and whether they were fully satisfied with their visit. Gather their feedback on things you could do better. You can have a staff member handle most of these communications, but an occasional follow-up call directly from you will work wonders in helping them feel valued and cared for.
Above all, remember: it begins with empathy.
Looking to the future of patient-centered care in radiology
“The years to come will continue to bring accelerated change to our field. As Julie Ritzer Ross wrote in a June 2017 article in the Radiology Business blog, “Patient-centered radiology and patient-centered radiology strategies will undoubtedly continue to emerge and evolve as healthcare reform marches on and an increasingly educated, highly engaged base of patients seeks tighter control of their own healthcare destiny. To survive in an era and environment where value is king, private practices and hospitals alike will need to embrace these strategies with open arms.”6
What steps have you taken to become more patient-centric? I welcome your comments!
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Klaus Erdbories is Vice President of Global Medical Sales at Carestream Health. He has 15 years of experience in medical imaging sales, operations and finance. His education includes an Executive MBA from IMD Business School.