
13 Nov Radiology Interaction: Are We Falling Short of the Target?
Whether radiologists like it or not, communication is an essential skill that impacts their work and patient safety. The quality of communication in a department can be measured, and there are many aspects to consider.
Radiographers should convey to patients the clinical reason for an investigation. They can also contribute to the development of clear examination protocols.
Patient Education
The quality of radiology services depends on clear and concise communication with patients for enhancing patient care. It is a fundamental patient-centered requirement that should start at the scheduling stage and continue throughout the imaging examination and result delivery processes. This includes making sure that the appropriate information is provided to the patient before the procedure, addressing patient’s questions and concerns, and providing timely results in a format that is understandable.
Radiology residents often have limited patient-facing communication skills, but they should be encouraged to develop their interacting with patients as a key part of their clinical and professional development. By helping them develop effective habits of communicating with patients early in their training, residency programs can improve patient care and ultimately enhance the future of the profession.
One of the most important aspects of good patient communication in radiology is the initial interaction with a radiologist, whether by telephone or in person, to discuss the need for an imaging investigation and the likely findings. This is a critical first step and one that should involve thorough and concise explanations of the presenting clinical problem and the examination plan. The importance of this first contact has been highlighted by a number of studies that have shown that the quality of patient perception of the care they receive in radiology is significantly influenced by this initial interaction with a radiologist.
Once the imaging examination has been performed, the radiologist must communicate the resulting diagnostic and management recommendations to the patient in written form. This can be challenging as there may be a significant amount of material to convey and the report format can vary considerably depending on the local protocol. In addition, the radiologist must also be prepared to break bad news when necessary.
Preprocedural patient education is also vital and it is recommended that radiology departments use a combination of traditional pamphlet-style information sheets and more modern digital tools, including educational videos, to ensure that patients are clearly informed before any procedure. This is especially important for invasive investigations where patients should be fully aware of potential risks and benefits, as well as the possible implications of their clinical outcome.
Referring Physicians
A key element in providing quality care is effective communication between the radiologist and the referring physician. This is especially true for critical or unexpected findings, which are expected to be promptly communicated to the referring clinician for the purpose of expediting diagnosis and treatment. While both the ACR and The Joint Commission have published practice guidelines that require timely communication of significant findings, radiologists often fail to meet these requirements due to heavy workloads and a lack of automated systems to communicate results.
Although there is no one-size-fits-all solution, a number of strategies have been suggested to improve the process of communicating significant or unexpected results in radiology. These include radiologists documenting such communications in a free-text section of their reports, radiology group meetings, and teleradiology services.
However, the most effective strategy for communicating critical results to referring physicians seems to be direct communication by the reporting radiologist. This has the added benefit of increasing referring physician compliance with follow-up recommendations. A recent study showed that referring clinicians who received their results directly from the radiologist were more than 25 percent more likely to comply with follow-up recommendations compared to those who did not receive direct communication.
The problem with this approach, however, is the difficulty of identifying the correct contact information for each patient in a large radiology department. This may result in a delay in communicating the results to the referring physician, or even failure to do so. It also creates a logistical nightmare for the interpreting radiologists, who are forced to perform clerical level work to track down the correct referring physician and communicate the results.
Another issue is that the referring physician might disagree with a radiologist’s interpretation or a finding, which leads to confusion and potential miscommunication between the two parties. This can be resolved by implementing clear local protocols for how an addendum or correction is added to the report, and how the radiologist and referrer are notified of any differences in opinion.
A final point to consider is that the referring physician may be unfamiliar with the terminology used in the report, which could lead to misunderstandings. This is where radiologists can help by ensuring that the reporting format is clear and concise, and includes sections on clinical details, technique, imaging findings and conclusions.
Staff
Although radiologists have variable degrees of direct contact with patients, they all must be able to communicate their professional findings and opinions to their colleagues and to referring physicians. This requires clear written and verbal communication. In addition, effective communication with non-radiologists is essential. This includes radiographers, nurses and clerical staff who often perform many of the tasks that the radiologist might otherwise do.
Radiologists can also be effective communicators at the institutional level by relaying their concerns to supervisors or recommending changes to radiology procedures, workflows and safety protocols. For example, Dr. Kanfi overheard a staff member comment that the transport room had no ceiling mirror to check for collisions and suggested that this could be improved. She emailed the radiologist who then got in touch with the building services department to have the mirror installed.
As with all aspects of hospital work, much that goes wrong in the radiology department can be blamed on poor communication. Fortunately, most of these issues can be audited and improved with appropriate strategies. For example, the radiologists should be aware of the number of imaging requests they receive, whether their recommendations are adhered to by the referring physician and other medical staff and how their reports are received by patients.
In addition, radiographers and nursing staff should be aware of the local protocol about when direct verbal communication with referrers will be initiated and how they will report such communications. This will help minimize the frequency of unnecessary repeat investigations and ensure compliance with the Ionising Radiation (Medical Exposures) Regulations 2000.
The final aspect of effective communication in Radiology involves publication. It is important that Radiologists make manuscript writing a regular part of their work and routine lifestyle. For this, they need to learn the art of writing early in their academic careers. They should be receptive to feedback from reviewers and be willing to revise their manuscripts in accordance with the comments of the reviewers. Moreover, they should appreciate that the scientific quality of their manuscripts is not only a prerequisite but is an intrinsic factor for deciding its fate in a biomedical journal.
Management
The practice of radiology is increasingly dependent on collaboration and communication between all stakeholders – not only with clinical colleagues, but also with technologists, business staff, healthcare administrators, and patients. This is in part because a paradigm shift has occurred, from one that prioritised volume of scanning to a focus on patient care and outcomes.
Unfortunately, many radiologists have received little formal education in patient-centred communication. This is a significant gap in training that should be addressed as it may lead to sub-optimal patient outcomes. There is a clear need for organised communication training and an opportunity exists to introduce this into radiology educational curricula at all levels.
In addition to the technical and medical aspects of the field, the communication of difficult news is an important area that requires special attention. This is particularly true in radiology where the radiologist is often at the centre of a life-changing diagnosis for the patient and their family. Koch et al developed a programme that enables radiologist to break bad news effectively in a manner that is appropriate to the individual situation.
It is also critical that a culture of openness and transparency exist in radiology, with the recognition that there will be instances where a finding needs to be communicated directly to the patient. This is particularly important when the results are a cause for concern such as in the case of cancer staging examinations or where there is a potential emergency. It is recommended that a protocol be established in the hospital for direct verbal communication with patients and that this is included in the radiology reporting system.
It is recommended that a structured and consistent approach to reporting be adopted, with a standardised lexicon and template, for example the RSNA ‘Normal Report’. This will improve communication between radiologists, referring physicians and patients. It is also recommended that a standardised form be used for communication of error, as this will improve consistency and reduce misinterpretation. It is important that the error be notified to the referring physician and the patient, as well as to the reporting radiologist, as this will enable learning from the incident.