Though lips may move, no one is listening

For as long as I can remember, both the American College of Radiology and the RSNA have emphasized communicating with patients. Personal contact and face time are the best ways. Clearly written instruction sheets, detailed descriptions of procedures, videotapes of complex interventions, and websites offering even more information are also available. In the case of mammography, the government has even mandated that a result letter be given to every patient.

I have embraced this approach for years in my practice. Communication is great, but there is a fly in the ointment-people ignore it.

I spend about half my workdays in our women's imaging center. I use the term "our" loosely, since the hospital owns it and we staff it. About 12 years ago, my partners and I designed and were going to open the first women's center in our area, as the hospital wasn't interested. At the last moment, the hospital board asked us to let them do it instead. In return, we would have an exclusive contract for all radiology services at our new regional hospital.

Of course, the next CEO chose not to honor this agreement and screwed us when the opportunity arose. I learned the half-life of a hospital administration's word is shorter than F-18's (which is fodder for another column), and thus we staff a very nice women's imaging center in the hospital. Our center is busy. I think we do about three million mammograms a day, and one radiologist reads them. There are also biopsies, dual x-ray absorptiometry exams, and several thousand ultrasounds. Not surprisingly, I occasionally fall behind, and patients have to wait.

When patients schedule an appointment for a diagnostic mammogram, they are told to allow an hour or two, unlike a screening exam. They are sent an information packet that contains a different-colored sheet of paper printed with large type telling them to allow an hour or two for their diagnostic exam. The difference between screening and diagnostic exams is explained to them. When they check in, large signs warn that a diagnostic exam takes longer. Yet every day-not just occasionally but every day-some lady is mad because she thought she would be here only 20 minutes. She either leaves or files a complaint.

Like most radiologists, I do a lot of biopsies. Every prospective biopsy patient gets a preop interview. All are cautioned about anticoagulants. Even if we didn't tell them (and we do, many times), common sense would suggest you don't want to be anticoagulated for a biopsy.

But you know what happens, because it happens to you. Every week, someone shows up for a biopsy swearing he or she had no idea that bleeding like a stuck pig after a biopsy was not OK.

My hospital seems to be one of the last in the U.S. with a busy fluoro schedule. Yesterday, I did nine upper GIs. I'm told a lot of residency programs don't do that many. And yesterday, like every day in fluoro, at least one patient was rescheduled because he ate breakfast before he came and said no one told him not to. Either our scheduling staff picks one person every day to frustrate, or people are not listening. I suspect the latter, as we also have the daily sneak-someone who ate, denies it, and thinks I won't notice all that crap in the stomach.

I have four children and a rather amazing wife. I love them dearly, and I know they love me. I am the king of a wonderful castle. That I spend all this time and energy trying to communicate with patients who don't want to listen might seem frustrating. But, it doesn't surprise me. No one listens to the king either.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at btipler@medicaltees.com.