Health Affairs: The downside of mammo efficiency
As breast imaging centers rush to pair efficient operations with a host of patient-friendly amenities, the wise will consider the negative impact of the assembly-line model, according to an essay published in the November issue of Health Affairs. In “Call It ‘Jiffy Boob:’ What’s Lacking When Care Has Assembly-Line Efficiency,” Colleen T. Fogarty, MD, family physician and assistant professor of family medicine at the University of Rochester in New York, detailed her experience at a high-volume, patient-friendly breast center.

The miscues started with the online scheduling system, which assigned Fogarty a Wednesday appointment--a direct contradiction to her initial request. The mistake forced a phone call to cancel and reschedule.

The center allows women to stay and wait for screening mammography results, an option that provided Fogarty ample time to observe operations.

Patient-friendly niceties such as neck-and-shoulder massages, complimentary herbal tea and a jewelry counter with proceeds directed to breast cancer program were plentiful in the tastefully designed waiting room, Fogarty noted.

As Fogarty passed from assistant to technologist to assistant and back again, she pondered the disconnect between efficiency, amenities and high-quality care. As the appointment stretched into a diagnostic ultrasound and needle biopsy, the deficiencies in the process became apparent. The physician-turned-patient experienced confusion, anxiety and loneliness.

“How great to have one-stop shopping--and how shocking, scary and bizarre… I’m left with the feeling that I’d been run through a 'breast mill,' passed among many staff members performing single tasks as they send me through their assembly line,” she wrote.

“My experience of being efficiently run through this breast mill, however, reveals the lack of a needed additional feature: care that centers on the patient,” Fogarty continued.

According to Fogarty, the well-staffed center perhaps lacked a key employee. A patient navigator or crisis assistant could steer and accompany frightened patients through the complex imaging process.

The less than patient-friendly experience dragged on when the radiologist delivered the unwelcome diagnosis of ductal carcinoma in situ by phone.

“There was no context--let alone sensitivity-to the bad news I was being given over the phone, or in the way it was being delivered.

“Yes, the doctor did her job; she was technically competent at managing the imaging equipment and biopsy and she personally provided timely results,” wrote Fogarty.

But the process omitted a critical element of someone “who would take care of me and walk with me, literally and figuratively, through the process of being a patient.”

In conclusion, Fogarty asserted, “We can’t just apply an industrial production model, creating a Jiffy Boob assembly line in an effort to achieve efficiency and productivity in healthcare,” and urged physicians to focus on the patient experience as well as the outcome.