Patient perceptions of the profession coupled with a new era in health care indicate its time for radiologists to take a more active role in patient care.

By Michael Bassett

Late last year, around the time of the Radiological Society of North America’s annual meeting in Chicago, a research study out of the University of Indiana School of Medicine received a particularly large amount of media attention.

 It seems that most patients know nothing about what a radiologist is or what they do.

The researchers surveyed 307 patients (half of whom had a college education) undergoing outpatient CT at the university hospital; 64% had little or no idea what radiologists do, despite the fact that 83% of them responded that it was important or very important to know who interprets their imaging examinations.

Sadly, the results of the study were not unexpected. “We weren’t too surprised by the results,” said Peter Miller, MD, a radiology resident at the school of medicine who led the study. “Similar studies had shown similar results. But I’m interested in having more interaction with patients and providing them with more direct care, so I wanted to do a study in our institution in the hope it can help us find ways to improve patient care.

“I do know that if I was a patient, I’d want to know who was taking care of me,” he added.

So why do patients—who apparently believe it’s important to know about radiologists—know so little about them?

Mary Mahoney, MD, compared radiologists to the “lonely repairman” in the old Maytag commercials. “We’re sitting down there in our [reading] rooms, all lonely and by ourselves,” she said. “PACS has just completely disconnected us.”

Patients see their family physicians in their offices and, if hospitalized, interact with physicians in that environment, says Richard B. Gunderman, MD, PhD, professor and vice chair of radiology at Indiana University School of Medicine, and senior author of the study. “But many patients are simply not going to see radiologists at work interpreting their studies.”

Gunderman is careful to point out that this lack of patient-radiologist engagement is not true across the board—breast imagers, interventional radiologists, and pediatric radiologists are all likely to connect with their patients in meaningful ways. “But for many radiologists, patient interaction is an infrequent event. And if patients don’t interact with radiologists and don’t see us at work, then I don’t think it’s reasonable to expect them to understand very much of who we are or what we do.”

At RSNA 2012, the association’s Patient-Centered Radiology Steering Committee launched the “Radiology Cares” initiative in support of RSNA’s effort to encourage radiologists to take a more visible and active role throughout the continuum of their patients’ radiologic care.  As part of the launch, Mahoney, who is the committee chair, presented a video patterned after Charles Dickens’ “Christmas Carol,” and, in particular, the part of the story featuring the Ghost of Christmas Past. In the RSNA video version, a radiologist has a dream in which he is chained to his chair in a dark room with a computer screen flashing more and more images he has to read, with a voice reminding him about RVUs and the need to read even more films.

“So the radiologist is thinking, ‘This isn’t what I thought I was getting into,’ and wonders how this happened,” Mahoney said. “And the answer is he removed himself from his patient and became a film reader and a commodity. The video was a little corny, but it was a way of asking radiologists whether this is the way they want the specialty to go. Do you really want to be just a film reader, sitting in this little dark room, with no patient interaction?”

Why is interaction important?

Radiologists are the imaging experts, Miller points out, so patients should be able to turn to radiologists if they have questions or concerns that need to be addressed.

More interaction with a radiologist makes a patient a more educated health consumer, says Gunderman, adding that if he has a better understanding of a radiologist’s work, then he may be in a better position to ask or answer important questions that can provide caregivers with important information. “Access to patient history and clinical information can be very important, and in many cases the patients are the best-informed people about their conditions,” he said.

There are also health care policy decisions being made that affect issues like access to care and reimbursement levels, and it won’t hurt to have knowledgeable patients on the specialty’s side when these policies are being debated. “If patients either don’t know what radiologists do or understand it poorly, that’s likely to be reflected in conversations they have with and letters they write to their representatives at the local, state, and national level,” Gunderman said.

From a radiologist’s perspective, Gunderman says, it can be “disheartening” to realize that so many patients have so little idea of what they do and how intimately they are involved in patient care. On the flip side, those radiologists who do interact with patients tell Gunderman that it turns out to be one of the most fulfilling aspects of their work.

“It could be something simple like showing a pediatric patient how well a fracture is healing or how a pneumonia is clearing, or something considerably more complex and life changing like a cancer that is melting away under chemotherapy,” he said. “At least some people think we can play a larger role in helping to educate patients about what our imaging studies reveal, and it may be good for us to feel a more direct connection with patients and see firsthand the difference our studies are making in their care and ultimately in their lives.”

Barriers

The geographical difference between radiologist and patient can be difficult to overcome, since, in some cases, radiologists and the patients whose studies they are interpreting could be on either side of a hospital, or even on the other side of town. And, in the case of teleradiology, radiologists may be in another state or even another country. “And that’s certainly going to make it a challenge to connect in any meaningful way with patients,” said Gunderman.

In addition, radiology work routines and department layouts also discourage radiologist-patient interaction. “I’m a breast imager, so I interact with my patients anyway,” said Mahoney. “We review images and results and spend a great deal of time talking to patients. But that’s a little different practice model from the rest of radiology, and for many of my colleagues, their normal day is sitting at the reading room with their computer module and looking at images.”

At RSNA 2012, Mahoney and her task force made an effort to get radiologists to sign on to the Radiology Cares pledge. She said the response she received from her colleagues was quite varied. Some said that patient interaction was something they already encouraged in their practices. “But others said they practiced in a place that really values volume and productivity,” she said. “And being available for consults and talking to patients and going to tumor boards really takes them away from that RVU-driven practice model.

“And that’s kind of a hard pill for me to swallow,” she said.

Like Mahoney, Gunderman recognizes that a desire to optimize throughput and efficiency can limit the number of times a day radiologists are going to interact with patients. “Of course, there’s another way of looking at that,” he said. “That taking care of patients is our highest priority, and the ability to interact with patients and their families shouldn’t be regarded as an interruption but as an opportunity to engage in what could be the most memorable and rewarding part of a radiologist’s day.”

So how can radiologists, if they choose, overcome these barriers to radiologist-patient interaction?

One thing that will help, Gunderman says, is if radiologists simply do a better job of getting their story out to the general public, something he attempted to do by writing a book, X-Ray Vision, recently published by Oxford University Press.

“If we have great resources that show some of the amazing pictures we show every day and also tell some of the remarkable stories of the patients whose lives have been touched and in some cases transformed by the work of radiologists, then that’s to everyone’s advantage,” he said “The stories are interesting in and of themselves and they enhance our appreciation for the complexity and beauty of the human body and lay the groundwork for more effective collaboration between patients and radiologists.”

RSNA is trying to do its part with its Radiology Cares drive, but Mahoney says that it’s important that radiologists understand that increasing their level of engagement with their patients means more than “I need to give results to patients.”

What she would like to see is a whole process change, “from the point at which the patient picks up the phone to schedule an exam, to the point where they actually get the results, and everything in between.” The goal, she says, should be to make that process more streamlined, more patient friendly, less confusing, and less invisible.

Miller believes that demographic changes within the specialty will have an impact, since, he believes, younger radiologists are more interested in interacting with patients—particularly since patients are so much more interested in and educated about their own medical care than in the past.

“I think the fact that patients are more educated and are playing more of a role in their medical care, kind of parallels what is happening in the medical world,” he observes, adding that specialties like radiology are filling up with new doctors who are just as eager to see their patients engaged in their own care.

“This is a gut check moment,” said Gunderman. “Do we want to operate like an industrial process, maximizing the output of an assembly line so we can interpret as many studies as possible in a given period of time, or do we want to see ourselves as partners and collaborators in the care of patients. I tend to favor the latter perspective.”

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 Michael Bassett is a contributing writer for Axis Imaging News.