“Patients are social animals, so personal/emotional connections with their healthcare providers are critical.” That was patient advocate David Andrews’ charge to attendees at the ACR Annual Conference on Quality and Safety, held in Denver in October. The 2019 meeting, which included sessions on topics such as just culture, clinical decision support, and empowering technologists, had a strong focus on the patient experience.
According to Andrews, who serves on the ACR Commission on Patient- and Family-Centered Care, patients know more about themselves than their physicians ever will. “Some of what patients know may be important in their diagnosis/treatment,” said Andrews. “That’s why radiologists need to be in direct conversation with patients as consultants. There is no one answer to what patients want. Each patient is different.”
Arun Krishnaraj, MD, MPH, vice chair for quality and safety at the University of Virginia Health System, agreed with Andrews. According to Krishnaraj, when radiologists engage in direct conversation with patients, they add immense value to the patients, referrers, and even themselves. But what does it look like for radiologists to connect with their patients? And how can they break down some of the existing barriers to make it happen?
According to Krishnaraj, radiologists can consider teleconferencing, videoconferencing, or participating in bedside rounding as a way to engage with patients. “Determine what small shift you want to make in your routine and then do it,” advised Krishnaraj.
Determine what small shift you want to make in your routine and then do it.
In addition to being in equal partnership with patients, the need for radiologists to address social determinants of health (defined as conditions in which people grow, live, and work) also took center stage at the meeting. According to Efrén J. Flores, MD, officer of radiology community health improvement and equity at Massachusetts General Hospital (MGH), radiologists and radiology practices need to take an active role in reducing the disparities that result from a combination of social determinants of health and health system factors. “Compassionate care is the first step towards health equity,” said Flores.
Flores noted that one way in which radiologists can take that first step is by replacing the term “no-shows” with a more compassionate term, such as “missed care opportunities.” “We use language blaming patients when they’re ‘no-shows’ or ‘non-compliant,’ when the reality is that they are facing extraordinary barriers to accessing care — and it is our job to do better,” said Flores. “We need more compassionate language and action that reflects our responsibility. By saying ‘missed care opportunity,’ we’re accounting for the healthcare system’s responsibility in patient engagement.”
According to Flores, inter-specialty collaborations and novel health delivery models are critical to overcoming the barriers to health equity and providing high-quality care. He advised radiology practices and departments to embark on equity initiatives by promoting culturally competent, high-quality care, fostering collaborative care to enhance quality, partnering with patients in their care, and reaching out and providing additional assistance to community health centers and clinics. One way in which Flores’ department at MGH accomplished this was by meeting patients with serious mental illnesses in a clinical setting they were familiar with to introduce lung cancer screening (LCS). As part of the program, MGH implemented a system change to facilitate immediate screening or scheduling for those who expressed an interest in the service.
“Our goal was to increase LCS in vulnerable patients seen by the Boston Health Care for the Homeless Program at MGH and by the MGH Chelsea Community HealthCare Center,” said Flores. “Our example is just one way in which radiologists can take an active role towards health equity,” said Flores. “When we all do this, we ensure that no patient gets left behind.”