The following is a summary of what we have learned through face-to-face patient communication in the embedded Head and Neck (H&N) reading room within the ENT clinic at Emory Hospital. While these patient encounters have convinced us that such communication is best for radiologists, referrers, and patients, we also acknowledge some obstacles and concerns over implementing the practice.
The major goal of direct patient communication is a paradigm shift toward patient-centered care to focus on the added value of the radiologist. We need to let patients hear from us, to show them that we are their doctors too and to clarify our role as the imaging experts. We are standing at the crossroads of huge opportunities and challenges. We need to step out of the reading room in order to gain clinical context to harness our own expertise and added value.
Obstacles and Enablers to Direct Patient Communication
There are roadblocks to overcome. Among these are radiologist workload, physical proximity to patients, and inconsistent (non-standardized) communication regarding next management steps. However, for each obstacle, we have found opportunities for enablers to support this practice, including our embedded H&N reading room, multidisciplinary relationships, subspecialty focus, and the ACR NI-RADS template to standardize communication regarding level of suspicion and next management steps.
- Convenient time/ radiologist workload: Emory H&N imaging is a busy practice with up to 60 complex cross-sectional studies per day, in addition to one or two image guided biopsies. Therefore, we can only offer this service on days where we are staffed with two H&N Neuroradiologists. We are fortunate that our leaders see the value in this communication. It is best to start small, with a specific group of patients and supportive referring clinicians,who can facilitate the consult and whose clinic is in close proximity to your reading room. It is important to let this physician know that there will be times when you must say “No” to a consult because of other obligations/time limitations. Our surgeons know to ask us before they offer this to the patient. Offering consultation services comes at a cost, as time spent away from interpreting studies means potentially less revenue. However, at a time when insurance companies persuade patients to choose the least expensive imaging study, radiologists directly interacting with patients may help attract and retain patients.
- Physical space and resources: Physical proximity can be an obstacle for many practices, so that consideration of how we structure our reading rooms is an important part of creating this opportunity. Embedded reading rooms in clinic space can facilitate this communication in a time efficient manner and facilitate finding a mutually convenient time and place for the radiologist and the patient. As noted above, these initiatives need the support of administrators and group physician leadership, in order to protect the quality use of the radiologist’s time and to prevent radiologists from performing time-consuming tasks that do not add significant value for patients.
- Radiologists’ uncertainty regarding treatment options or referrers’ concern that radiologists will cause patient anxiety: This is the most troublesome argument against radiologist- patient interaction, primarily because it reveals an underlying lack of trust on the part of referring clinicians and potentially sheds doubt on the radiologists’ added value. To ensure that treatment options and the impact of imaging findings are conveyed to patients to the best of our ability, all radiologists should make a concerted effort to understand treatment implications when interpreting a study. Management-based templates can help the general radiologist, because they have largely been developed by experts in the field working closely with referring clinicians using a multidisciplinary approach for best practices. These templates will inform radiologists about the appropriate next steps even when they are uncertain of the diagnosis. A guiding principle is that it is “ok to be uncertain of the diagnosis, but we need to be certain of the next step in management.” These templates can give radiologists more confidence in their interpretations, next steps and therefore potential patient interactions. It is also important for radiologists to remember that no single physician has all the answers and that every physician may say, “I don’t know, but Dr. X can better answer that question.” Other times, the appropriate response will be, “You and Dr. X can decide together the next step in your care, as the radiology expert, my responsibility is to explain these imaging findings so you can make the best decision.”
Benefits of Direct Patient Communication:
We have seen firsthand the overwhelmingly positive impact on our patients. In this study we found that 56 percent of patients wanted to hear only from the referring physician before an opportunity to meet the radiologist. After meeting with the radiologist, we saw a clear turnaround in the patients’ mindset, as nearly 93 percent of patients wanted to review their studies with their radiologists in the future. A picture is worth a thousand words. Patients feel cared for when we tell them that we are their doctors behind the scenes, looking everywhere in their neck that their surgeon or oncologist cannot see or feel. If there is an abnormality, it helps them to see it, understand the next steps, and feel confident with our plan to follow up or sample it.
Referring clinicians appreciate our expertise and willingness to put patients first. With careful planning and utilizing their clinic space or a consult room, our surgeon even noted that his clinical workflow improved with a transition to a quick consultation with the radiologist.
This is not only critical for patient -centered care but also radiologist-centered practice, resulting in greater job satisfaction and fueling physician wellness. For the one or two patients that I may speak with in a day or week, it helps my perspective, and therefore interpretation on the other 45 patients, whose scans I’m reading that day. Showing our value is critical. This is especially true as we redefine and explore new reimbursement models. The major enablers for better communication with referring clinicians and patients include embedded reading rooms, multidisciplinary relationships, management based templates such as NI-RADS and learning from other patient facing radiologists. Direct communication with patients increases value, with repercussions consequences far beyond the one or two patient interactions. As we branch out of the reading room, we gain perspective and wisdom regarding patient management, the implications of our interpretations, and ways to improve the system.