Breast Imaging a Model in Radiologists’ Relationships

CHICAGO - As radiologists work to stay relevant and embrace a more patient-centered practice model  in an evolving health system, breast cancer imaging may provide a useful model for others in the field to emulate, according to Michael N. Linver, MD, director, Mammography X-Ray Associates of New Mexico at the Radiological Society of North America (RSNA).

Linver, a clinical professor of radiology at the University of New Mexico School of Medicine, spoke at the session “Unsolved Dilemmas in a Digital World: Improving Radiologist and Technologist Communication” and said the key to success in this model is a respectful relationship between the radiologist and breast imaging technologist.

Strong communication and good relationships with other team members, like referring physicians, and patients also are important, he said.  These relationships, he emphasized, are essential for radiology practices that want to remain relevant in the face of reimbursement pressures, outsourcing, and encroachment into imaging by other specialties.

“We need to provide a service that can only be provided in person, that no one else can,” he said.

Linver outlined the lessons radiologists can learn from successful breast imaging practices. He explained that breast imaging teams include the radiologist and dedicated technologists in mammography or magnetic resonance imaging, tech assistants, and a nurse-navigator. The breast-imaging radiologist is the “lynchpin” for the team and must set a positive tone for working with patients.

He said it is important for the radiologist team leader to meet with patients to help allay fears, get a good history, explain any findings, and break bad news. He offered tips on how to show patients respect and make them comfortable during interactions. For example, he said, he has two chairs in every room so he can sit next to his patients and speak to them on the same level. He stressed the importance of body language that is open and non-threatening.

“Never speak down to the patient,” Linver said. “You have to use words they understand. No jargon.”

He noted that patients receiving bad news may be afraid and in shock, so they may not hear or understand what their radiologist is telling them. He said he likes to give them his card, write the diagnosis on the back so the patient can look it up online, and invite the patient to call with follow-up questions.

Good patient relationships, he said, are essential to good care. Positive relationships also provide a marketing bonus. Women who have had a good experience with your practice will refer others, he noted.

“Patients assume you are competent, but they can measure your affability and availability,” he said.

The team technologist’s professionalism is just as critical to success, he emphasized. He noted that technologists have more contact with patients than anyone else on the team. They are responsible for meeting MQSA quality standards, working seamlessly with the front desk, and being a second set of eyes if the radiologist misses something in an image.

The patient navigator is a newer role in the breast imaging practice. This individual helps work as a physician-extender and may be a nurse or technologist, Linver said. He or she may deliver non-cancerous results, assist patients in accessing services, and provide one-on-one patient education.

To help his team stay engaged and up-to-date, Linver said he regularly brings in outside trainers. He also involves his team members in efforts to improve workflow and ergonomics.

“You must have strong relationships of respect and trust,” Linver said.

He also recommended that radiologists maintain strong relationships with referring physicians and play an active role in clinical decision-making.

“If we as breast imagers abdicate this role, physicians will look elsewhere,” he said.