New Approaches to Patient-centered Radiology

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Susan JohnElliot FishmanPatient-centered health care has been a buzzword for some time, but the middle ground where patients and their providers meet is always shifting, according to the presenters of a December 3 session at the 2013 annual meeting of the RSNA in Chicago, Illinois. Susan John, MD; Elliot Fishman, MD; and Brent Wagner, MD, presented “Patient-Centered Radiology” to explore how engagement with patients is changing. As Wagner puts it, “All the things we might do to make our practices more patient-centric are a balancing act between opportunities and challenges.” Each of the speakers looked at a different facet of patient care. John focused on how radiologists interact with their patients face to face; Wagner explored the use of patient portals to share results and offer chances to engage; and Fishman glowingly endorsed the use of social media as a means to improve patients’ experiences with the profession as a whole. Face Time John is the J.S. Dunn distinguished chair of radiology at the University of Texas Medical School at Houston. In her capacities as both a practicing radiologist and a professor, she often considers what residents are being taught, in terms of caring for patients—including the 2002 addition of patient-care, interpersonal, and communication skills and professionalism as core competencies for budding radiologists. “In radiology, patient-centered care includes effective communication with patients, families, and caregivers,” she says. In surveys, John says, patients have asked for easy access to their physicians, for the ability to see their study results, for some face time with their physicians, and for some degree of price flexibility and cost transparency. These are dimensions of the patient’s care experience that radiologists rarely have cause to consider; as John points out, “We all think we care about our patients, but we have to remember that the patient experience goes way beyond our interpretation.” What is John’s prescription? When interacting face to face with patients, radiologists should focus on being honest, consistent, and respectful of patients’ privacy; their communication should be clear, empathetic, tailored to patients’ needs, and welcoming of participation from families and friends. “Good communication requires practice,” she adds. “Radiologists need more opportunities to talk and work with patients.” Patient Portals Wagner, who is president of West Reading Radiology Associates in Pennsylvania, steps in with a private-practice perspective (one that places even more emphasis on efficiency). “If we’re not dictating actively, we don’t feel we’re being efficient,” he says. “I would argue that we need a broader view of that.” Radiologists can take the time out of their days to deliver results to patients in person, but doing so doesn’t just create an efficiency issue: It can also step on the toes of referrers. “The people who are most opposed to giving results to patients are referring clinicians,” he says. “Many of my clinicians would prefer I not talk to my patients. They feel it confuses them and erodes their relationship.” By making full use of patient portals—which can put a three-day hold on results, out of deference to referrers—radiologists can maintain high efficiency while creating a fresh touchpoint with their patients, Wagner argues. “There’s no value to patients in waiting for reports,” he says. “They want reports instantaneously.” He adds that he has personally taken the controversial extra step of adding his cell-phone number to the bottom of the report, along with an invitation to call with any questions. “Everyone said I was crazy, but so far, I haven’t gotten a single call,” he says. The openness of the radiologist to communication may be enough for the patient to feel that he or she has been offered “a higher level of service through personalized communication,” Wagner says. Social Media Elliot Fishman, MD, who is the director of diagnostic imaging and body CT for Johns Hopkins Medicine (Baltimore, Maryland) and who tweets as @ctisus, began his portion of the talk by noting that if a radiologist had asked him, three years ago, whether he or she should be using social media in a professional capacity, he would have said no. Now, he says, the question is not whether to use platforms such as Facebook and Twitter, but how. “Instead of being afraid of our patients finding health information online, we should be trying to reach them there,” he says. Fishman points to evidence that using social media as a communication tool in health care is here to stay, including a host of peer-reviewed papers (outside radiology) on the topic, as well as a recent survey1 in which almost half of those questioned said that they wouldn’t mind sharing health information via social media. In the same survey, more than 70% of patients said that they would be interested in receiving help from their physicians through social media. The University of Michigan has recruited online patient advisors using its social-media presences, and an upcoming article in the Journal of the American College of Radiology: JACR will finally rectify radiology’s absence from the topic, in the medical literature, by looking at how Twitter was used during the 2012 annual meeting of the RSNA. Fishman points out that if health-care players who don’t suffer from patient-awareness issues are using social media, radiologists need to catch up—quickly—or risk being as invisible online as they have been in the hospital. Using social media is “an opportunity for radiologists to share with patients who we are,” he says. The most important thing for radiologists transitioning to patient-centered care to do is to remain adaptable in the face of change, the speakers agree. “We are living in a world that is different from the practice of radiology 10 years ago—or even five years ago,” Wagner says. “The expectations that we have of ourselves as clinicians—and that the public has of radiology as a profession—have changed.” Cat Vasko is editor of and associate editor of Radiology Business Journal.