Question

Can you provide examples of how radiologists can promote health behaviors?

Answer 1

A patient’s experience is the sum of all their interactions, and it’s shaped by our organizational culture. It influences their perceptions across the continuum of care.

The traditional view of the radiologist as a physician who adds value to the health care system solely by generating and interpreting diagnostic images is outdated. The radiologists’ roles have expanded to encompass economic gatekeeping, political advocacy, public health delivery, patient safety, quality of care improvement, and information technology. It is through these roles that radiologists will continue to find new ways to add value to the healthcare system.

Patient-centered care (ie, care organized around the patient) is a model in which health care providers partner with patients and families to identify and satisfy patients’ needs and preferences. In this model, providers respect patients’ values and preferences, address their emotional and social needs, and involve them and their families in decision making. Radiologists have traditionally been characterized as “doctor-to-doctor” consultants who are distanced from patients and work within a culture that does not value patient centeredness. As medicine becomes more patient driven and the trajectory of health care is toward increasing patient self-reliance, radiologists must change the perception that they are merely consultants and become more active participants in patient care by embracing greater patient interaction. The traditional business model for radiology practices, which devalues interaction between patients and radiologists, must be transformed into a patient-centered model in which radiologists are reintegrated into direct patient care and imaging processes are reorganized around patients’ needs and preferences. Expanding radiology’s core assets to include direct patient care may be the most effective deterrent to the threat of commoditization. As the assault on the growth of Medicare spending continues, with medical imaging as a highly visible target, radiologists must adapt to the changing landscape by focusing on their most important consumer: the patient. This may yield substantial benefits in the form of improved quality and patient safety, reduced costs, higher-value care, improved patient outcomes, and greater patient and provider satisfaction.

While the term gatekeeper has traditionally been applied to primary care physicians, the radiologist can also have a role in insuring that medical resources are utilized efficiently and appropriately. A gatekeeper can be defined as a person who is positioned between an organization and the individuals who wish to utilize the resources within that organization. While the primary care physician may be the patient’s first contact in the medical system, the radiologist often becomes involved in the initial diagnostic workup. Moreover, the results of the radiological examination may determine the need for additional diagnostic tests, specialist referral and/or hospital admission.

Technologists play a central role in the radiology department, and many of their responsibilities depend on effective communication with patients: taking histories, verifying patients’ identity and the procedure to be performed, screening for safety, providing instructions and ensuring that patients understand all instructions, answering questions promptly and accurately, explaining postexamination care, and coordinating patient care with efficient and effective use of resources. Because technologists play a central role, strategies that improve their communication skills are paramount for ensuring patient safety and a positive experience. The acronym AIDET (acknowledge, introduce, duration, explanation, thank you) refers to a set of skills that can be used to improve communication between patients and health care providers in a radiology department: (a) acknowledge: greet and welcome the patient, apologize for delays, and acknowledge concerns; (b) introduce: introduce yourself using your name and explain your role in the patient’s care; (c) duration: describe the amount of time the patient can expect to wait for a test or procedure; (d) explanation: describe what is going to happen to the patient and what he or she can expect; and (e) thank you: thank the patient for his or her cooperation and participation.

Examples of patient-centered communication skills include encouraging patients to talk about psychosocial issues, using the patient’s own words and language, and providing information and counseling rather than asking questions and giving directions. Attention to patients’ emotional concerns and explanations of procedures were identified by patients as aspects of care that could be improved during diagnostic imaging procedures such as double-contrast barium enema examination, mammography, abdominal ultrasonography (US), and vaginal US. The radiologist can also assist the primary care physician in their gatekeeping role not only by recommending appropriate imaging follow up but also by sometimes recommending the appropriate referrals to specialists.