“Listen to the patient.”
—Sir William Osler
Dr. Osler was perhaps the earliest practitioner of patient-centered medicine. More recently, Stewart et al divided the paradigm for patient-centered medicine into six general domains of activity: 1) exploring the disease and illness experience; 2) understanding the whole person; 3) finding common ground regarding management; 4) incorporating prevention and health promotion; 5) enhancing the doctor–patient relationship; and 6) being realistic about time and resources. What do we, as radiologists, do if we do not routinely see the patient? How does one practice patient-centered radiology in these circumstances?
The following domains of patient-centered radiology can be proposed: 1) radiologist–patient relationship; 2) structure and process of care and delivery of imaging services; 3) needs anticipation and patient preferences; 4) communication and shared-decision making; and 5) patient-centered outcomes. Communication, a key component of patient-centered radiology, has been explored in other annual issues of the Radiology Alliance for Health Services Research predominantly in the practice of breast imaging , the subspecialty of radiology most visible to the patient. The rest of us toil in anonymity. Neiman’s review of the American College of Radiology’s “Face of Radiology Campaign” underscores just how invisible we are despite the escalating use of imaging services .
Restructuring the process of imaging can reintegrate radiologists into the process of patient care rather than being relegated to consultants to referring physicians. Kerlan and Brant-Zawadski present a template for such restructuring that encompasses the initial encounter with the radiology practice during scheduling and the final encounter during communication of results . Facilitating the enhancement of imaging care delivery is the coherent use of informatics for decision support and computer-aided diagnosis as described by Rubin et al .
The current pattern for communication of imaging results rely on the referring clinician as an intermediary between the radiologist who generates the information and the patient who is the ultimate consumer. This antiquated flow of information has the potential for delay or miscommunication and is contrary to the patient values of timeliness and reduction of uncertainty. In a recent study of smokers undergoing lung cancer screening, waiting for the results led to discomfort in half of the study participants . Reducing radiology turnaround time addresses only part of the time delay. Radiologists can potentially eliminate the delay by sending the results directly to the patients and can mitigate patient anxiety over the results by being available for patient queries .
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
References
1. Stewart M., Brown J.B., Weston W.W., et. al.: Patient-centered medicine: transforming the clinical method. Thousand Oaks, CA: Sage 1995;
2. Sasson J.P., Zand T., Lown B.A.: Communication in the diagnostic mammography suite: implications for practice and training. Acad Radiol 2008; 15: pp. 417-424.
3. Lown B.A., Sasson J.P., Hinrichs P.: Patients as partners in radiology education: an innovative approach to teaching and assessing patient-centered communication?. Acad Radiol 2008; pp. 15425-15432.
4. Hardin V., Nguyen S.A., Ravenel J.: Is e-mail communication effective in changing ordering patterns in the emergency department: a case study of CT for pulmonary embolus. Acad Radiol 2008; 15: pp. 433-437.
5. Neiman H.L.: Face of radiology campaign. Acad Radiol 2009; 16: pp. 517-520.
6. Brandt-Zawadski M., Kerlan R.K.: Patient-centered radiology: use it or lose it. Acad Radiol 2009; 16: pp. 521-523.
7. Rubin D.L.: Informatics methods to enable patient-centered radiology. Acad Radiol 2009; 16: pp. 524-534.
8. van den Bergh K.A., Essink-Bot M.L., Bunge E.M., et. al.: Impact of computed tomography screening for lung cancer on participants in a randomized controlled trial (NELSON trial). Cancer 2008; 113: pp. 396-404.
9. Swan J.S., Lawrence W.F., Roy J.: Process utility in breast biopsy. Med Decis Making 2006; 26: pp. 347-359.
10. Swan J.S.: A software application for multiattribute utility models. Acad Radiol 2004; 11: pp. 190-205.
11. Swan J.S., Sainfort F., Lawrence W.F., et. al.: Process utility for imaging in cerebrovascular disease. Acad Radiol 2003; 10: pp. 266-274.
12. Kielar A., Carlos R.C.: Health related quality of life and cost-effectiveness analysis in radiology. Acad Radiol 2007; 14: pp. 411-419.
13. Reed M.H.: Clinical decision rules in radiology. Acad Radiol 2006; 13: pp. 562-565.
14. Sanelli P.C., Gold R.L., Greenberg E.D., et. al.: Work-in-progress toward incorporating patients’ preferences in practice guidelines for imaging aneurysmal subarachnoid hemorrhage. Acad Radiol 2009; 16: pp. 535-540.
15. Kelly A.M., Dwamena B.A., Cronin P., Carlos R.C.: Breast cancer: sentinel node identification and classification after neoadjuvant chemotherapy—systematic review and meta analysis. Acad Radiol 2009; 16: pp. 551-563.
16. Kielar A.Z., El-Maraghi R.H.: CT colonography versus optical colonoscopy for screening asymptomatic patients for colorectal cancer: a patient, intervention, comparison, outcome (PICO) analysis. Acad Radiol 2009; 16: pp. 564-571.
17. Mankoff D.: Molecular imaging research in the outcomes era: measuring outcomes for individualized cancer therapy. Acad Radiol 2007; 14: pp. 398-405.
18. Shimony J., et. al.: Resting-state spontaneous fluctuations in brain activity: a new paradigm for presurgical planning using fMRI. Acad Radiol 2009; 16: pp. 578-583.