Patients want doctors to be highly trained and skilled with the technology that has led to so many health improvements in this century. Patients also need doctors to notice their emotions, and recognize that what is “routine, typical and straightforward” to doctors, almost never is to patients.
In 2009, I underwent a screening mammogram that rapidly turned into an unanticipated diagnostic procedure. During the highly efficient, same-day procedure, I was passed from assistant to assistant for more testing and finally the biopsy.
While no staffer was unkind, I felt de-humanized by the experience; no one seemed to understand that while routine for the staff, this was new and scary information for me, even as a doc myself. When the radiologist likened the biopsy table to Jiffy Lube, my sense of being run through a machine was complete 1.
A patient who needs a radiologic test or procedure is, by definition, someone who has a concerning finding. Patients may be afraid of the uncertainty of the finding, perhaps ruminating on the question “is this cancer?” Patients may be intimidated or frankly intolerant of imaging equipment, such as a closed MRI system.
A few simple tips could greatly enhance the patient’s experience of being cared for and won’t add much time to a visit.
- Build a “bridge” to the referring clinician, and ascertain the patient’s concerns. “I understand Dr. Fogarty sent you in for your mammogram today. Do you have any particular concerns?”
- Acknowledge, and don’t minimize, any emotion the patient tells you, especially worries or fears. Recognize that some procedures can be uncomfortable, and the difference for some patients between discomfort and pain can be their perception of their level of control and sense of support. “I’m glad you told me that you’re worried about the pain of the mammogram. Most women find it an intense pressure, but not as much pain. We’ll talk you through it, so that it will go as smoothly as possible.”
- Give the patient clear information, in small doses. See what the patient understands about the information you have provided. Give the patient a few minutes to digest the information, and check back for further questions or points of clarification.
- In a “crisis” situation, one involving an unexpected finding or need for additional testing, slow down. Follow step 3, and consider asking a staffer to sit with the patient to provide moral support. Ask your staff to assist the patient in calling family or support people to let them know what’s happening.
- Words count. While it is critically important to be honest with patients about what to expect, it’s equally important not to over- or under-emphasize what they may experience. For example, saying “This will feel like a bee sting” probably isn’t really true. A more helpful and honest approach might be, “The numbing medicine may sting or burn going in. Take a slow breath to help with that, and within 60 seconds you’ll start to feel numb.” This type of coaching gives the patient useful anticipatory information, as well as a specific behavior they can use to cope with it.
With practice, these communication tips will go a long way to providing the emotional support that patients crave from their healthcare team. Radiologists can take the lead in incorporating these tips into their practice, and set high expectations for the entire treatment team to engage in these supportive behaviors.
1. Fogarty CT. Call it ‘Jiffy boob’: What’s lacking when care has assembly-line efficiency. Health Affairs November 2011;30(11):2204-2207.