You don't have to be perfect. We don't have to report and measure every change we make. We can simply treat our patients how we would want to be treated.
During the 2017 RSNA meeting, Jennifer L. Kemp, MD, a body imager with Strategic Radiology member practice Diversified Radiology, Denver, CO, was awarded with the Minnie Award for Scientific Paper of the Year from Aunt Minnie editor-in-chief Brian Casey. Kemp received the award as lead author of a paper published in Radiology that described the findings of an RSNA survey exploring radiologists' opinions about patient-centered radiology.
Kemp shared a few thoughts with Strategic Radiology about her award-winning research paper, which revealed some interesting results about the experience and attitudes of radiologists when it comes to patient communication, among them:
· 89% of respondents agree that promoting awareness of radiology's role in patients' overall healthcare is important. But only 31% of respondents state they are currently promoting awareness of radiology's role in healthcare.
· 71% of respondents agree that it is important to be available to patients for questions following their procedure, but only 49% currently report practicing in this manner.
· a key observation of Kemp and co-authors that “there is a disconnect between what radiologists believe is important and how radiologists are practicing.”
When it came to barriers to communication, there was not much difference between private and academic practices, who agreed that time or workload (73%) was the biggest stumbling block to direct communication with patients.
Significant differences were seen, though, between the responses of radiologists in subspecialties with characteristically more patient interaction (e.g. interventional, breast imaging) and those for which it is rare. The former were significantly less likely to report that time/workload (60%) were barriers than the those subspecialties with less direct patient interaction (80%).
Another question got to the heart of why it is worth making the effort to overcome barriers: What could encourage more communication with patients? A personal sense of satisfaction was the most-cited motivator, chosen by 74% of respondents compared to only 57% who would be more motivated by CMS reimbursement. Kemp believes this survey result underscores that radiologists are more intrinsically rather than extrinsically motivated.
Getting on the Bus
Kemp is a body imager, not a specialty normally associated with patient interaction. Her consciousness around patient-centered radiology was raised when her husband received a cancer diagnosis and she experienced radiology from the perspective of a patient with a serious diagnosis, albeit second hand. That experience prompted her to join the RSNA Patient-Centered Radiology Steering Committee as it formed in 2011.
Kemp was pleased but not surprised to see that survey respondents chose a personal sense of satisfaction over reimbursement as the prime motivator for direct patient communication. “I don't like the emphasis on ‘incentivizing’ physicians,” she says. “ I think most physicians are drawn to doing the right thing for our patients. Monetary incentivization does little to incentivize. People performing high-functioning tasks are motivated by autonomy, mastery, and purpose—as noted by Daniel Pink in his book Drive. Our survey results confirmed this.”
The Patient-Centered Radiology Steering Committee collaborated with the RSNA Research Department to develop a survey that would produce a better understanding of the state of patient-centered care in radiology. “Our survey focused on radiologist/patient interaction, but our steering committee really wants to stress that being patient-centered includes much, much more than direct patient interaction,” Kemp says.
Kemp emphasizes that there are opportunities to be more patient-centered all along the continuum of patient care when patients visit an imaging department—from parking to registration, from making sure the patient is having the best test to answer the question at hand to the technologist explaining the exam, having up to date accurate imaging protocols, access to comparisons, availability to the patient or their referring physician for questions, actionable clear evidence-based reports, and even the clarity of the radiology bill.
What You Can Do
When asked, Kemp offered three things every radiologist can do to make their care more patient-centered:
· Review exams in the morning to make sure the correct tests are being ordered for the question at hand.
· Put phone numbers on the reports so that radiologists are easily accessible for patients or referring physicians.
· Review and simplify our exam preparation instructions.
In a video of Kemp posted on the Rose Medical Center, Denver, Colo., where she is on staff, Kemp invites patients to reach out to her with questions and shares that her phone number is on every report she generates.
She says that her experience as a member of the RSNA Patient-Steering Committee has and continues to change how she practices. “I’m continually taking small steps, and learning from my fellow colleagues on the steering committee,” she says. “ Our latest step towards being more patient centered in my practice involves allowing the technologists after ultrasound, CT, or x-ray during certain slower hours of the day to offer patients the option to wait for the radiologist to review exam, after which the radiologist will speak to the patient to provide immediate results.”
What Your Practice Can Do
Recognizing that for most radiologists, patient interactions represent unreimbursed time, the authors suggested that future patient-centered strategies should focus on ways to accomplish this that would maintain productivity and revenue. One suggestion the authors made was to focus at the policy level to include radiologist–patient communication in quality measures.
“PQRS 2016 Radiology Preferred Specialty Measure Set includes patient-centered quality measures such as appropriate use and radiation reduction, but does not include radiologist and patient communication,” they wrote. ”Further efforts toward incorporation of direct communication into these metrics may prove a useful focus of political advocacy.”
The authors also suggest integrating reading rooms in subspecialty clinics and connecting with patients via social media, strategies that Strategic Radiology practices could consider. “The Society of Abdominal Radiology sponsors a Twitter account that directly answers patient questions about prostate cancer,” she notes.
Kemp encourages practices to jump in and take small steps. “You don't have to be perfect,” she says. “We don't have to measure and report every change we make. Metrics are great, but they are intimidating and can get in the way of making changes. We can simply treat our patients how we would want to be treated.”
Kemp JL, Mahoney MC, Mathews VP, Wintermark M, Yee J, Brown SD. Patient-centered Radiology: Where are we, where do we want to be, and how do we get there? Radiology. 2017 Nov;285(2):601-608. doi: 10.1148/radiol.2017162056. Epub 2017 Jun 20.
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