Over recent years,
particularly over the last 5 years,
a big concern has come to the forefront in the Radiology Community,
“The radiologist’s invisibility”. Different strategies have been proposed to address it.
If patients,
other doctors and ourselves do not understand our role in radiology,
in patient care and in the Health System,
our future becomes uncertain.
If radiologists become invisible,
we will become replaceable,
without a future.
1.- Loss of the Radiologist’s visibility
Since the development of CT in the 1970s and MRI in the 1980s radiologists have become less visible to patients (with a few exceptions such as interventional radiology and gastroenterology).
The radiologist invisibility has been the subject of debate in radiological scientific societies and radiology congresses,
especially in the European and American ones (ECR,
RSNA,
ARRS); Deborah Abrams Kaplan: The Radiologist’s Image (Diagnostic Imaging,
2012,
http://www.diagnosticimaging.com/).
There are also many publications warning about the essential invisibility of radiologists,
which needs to be addressed urgently,
particularly in a hostile background,
when our value and function is being questioned due to the emergence of teleradiology,
and turf battles with other disciplines on some areas of imaging (1,
2,
3).
There are some questions that radiologists,
Radiological Scientific Societies and Health Authorities must answer if we want a "visible" future:
1.1.- What do our patients know about what a radiologist is or does in a radiology department in the Health care system?
1.2.- How is it that radiologists are so invisible to their patients and what is the long-term consequence of this loss of visibility ?.
1.3.- What were the main factors that led us to this invisibility,
considering the breakthrough of radiology over the last century ?
1.4.- Who is giving the information about radiation doses or radiological reports to the patients?
For the last several years,
Radiology Departments have moved further away from a patient-focused model to concentrate on volume of studies (Mary C.
Mahoney,
MD,
said at RSNA 2015: https://www.rsna.org/Mary_C_Mahoney.aspx).
This has resulted that radiologists are for most patients,
the personnel running the "photo department".
In a recent study in Belgium,
almost 50% of surveyed patients did not even realize that radiologists were doctors and 62.2% of the patients wrongly identified the radiographer as a radiologist (4).
Direct contact between radiologists and patients is scarce.
For the patients,
radiological exams may seem like some painful or inconvenient intrusion into their privacy,
carried out in a mysterious or frightening place.
The perception is further altered by the fact that patients typically do not choose their radiologist; the referring physician,
the Health Service or another intermediary usually makes that choice.
Historically,
radiologists’ official written reports have functionally been proprietary communications between radiologists and referring physicians.
Although never secret,
these reports have traditionally been archived in the medical record,
with tightly controlled access.
Patients rarely viewed reports directly.
2.- The future patient: “the emerging patient”
The “emerging patient” is a proactive patient who uses Information and Communication Technology and takes responsibility for his/her own health ( table 1).
Our patients have changed and use Health Apps and Internet actively (www.somospacientes.com/).
Table 1.- “Emerging” patients.
ARE INFORMED
about their disease and available therapeutic alternatives
|
INTERACT
with the other agents of the health system on the Internet
|
REQUIRE
immediate responses via any digital channel and anywhere
|
KNOW
their rights and demand answers adapted to their needs
|
Patients are informed people and are no longer satisfied with passive information regarding their health.
They even have congresses and have started to attend and give presentations in medical congresses (http://www.meetup.com/es/Health-2-0-Barcelona-Chapter/events/227592279/)
and are members of Patients’ Associations and Committees with an active presence on Internet social media networks.
The health information web portal and patient portals are a reality (5).
Patients have knowledge about radiation doses.
Cancer patients want more information about the risks and benefits associated with radiation in the exams they undergo.
They want to understand how tests like PET,
CT and MRI differ and why one specific test is selected instead of another,
or why multiple tests are sometimes ordered (6).
The dark side of Internet for patients is the danger of unfiltered information.
Every day more and more patients rely on Dr.
Google to request information for their health problems.
And the Internet,
in inexperienced or biased hands has the potential of causing enormous damage.
On the Internet we can find everything,
from sensible information and recommendations to absurd but appealing theories that can lead the patients astray.
It is well-known the case of a famous guru of an important computer company whose incorrect information,
analyzed without basic knowledge,
led him to a misleading decision and finally to his death.
Internet does not mean that physical doctors will not be necessary.
In fact,
physical doctors are more necessary than ever to guide the patients through the forest of contradictory information that Dr Google throws at us.
And also,
the importance of trustworthy WebPages coming from prestigious sources like scientific associations should not be underrated.
3.- What are the present and future role of the radiologist in a patient-centered health care system?
Radiology is now the key diagnostic tool for most diseases and has an important role in monitoring treatment and predicting outcome.
Many of the treatments that are available today are based on the results of imaging tests.
There is no doubt that the future of healthcare will be technology-driven,
and it’s hard to find a medical specialty more grounded in technology than radiology.
Transparency is now a public and professional expectation where radiologists have much to gain regarding visibility.
4.- How To be visible to our patients and Medical Community?
Radiological Professional organizations must intensify their existing efforts to familiarize the public and the media with the radiologist’s invaluable role in medicine and healthcare,
and patients’ need to view their doctors as partners,
take an active interest in their health,
and "co-author" their records.
Because there is no ‘one size fits all’ approach,
the best opportunity to improve patient care to patient-centered care,
is to respond to the wide range of desires with an appropriately wide-ranging variety of information,
then allow patients to choose what best suits their needs.
The radiologists should lead the change,
"This is a responsibility that radiologists should relish,
pursue,
and take seriously.
We should be leading change because if you let someone make changes who doesn’t understand what we do,
it will be damaging our patients,” (Frank Lexa,
MD,
MBA. Radiology residency director for Drexel University College of Medicine,
at RSNA 2015.
http://www.diagnosticimaging.com/rsna-2015/radiologists-need-lead-change?).
We need to step out from behind the monitors to adopt a leadership role in healthcare being visible to patients.
We must introduce ourselves to our patients,
explain the procedures of the radiological examination,
and directly communicate results and report to the patient.
We must advocate for radiological installation design that promote radiologist-patient interaction.
The radiologist must be at the centre of a multidisciplinary team in the health care process.
“Social media use is just one of a number of ways that you can increase your communication with those you serve,
their caregivers,
and with others in the health care arena to gain insight on how you might improve the care you provide and your patient’s satisfaction with that care.
“We either have to lead using digital tools or the digital tools will take it away from you”.
(James V.
Rawson,
MD,
FACR.
chair of the ACR.
Commission on Patient and Family-Centered Care.
ACR.org).
5.- Visibility measures taken by radiology Societies
The American College of Radiology and the RSNA stated 5 years ago: "Give radiology a face!”; and how to communicate with patients and how to make Radiology more patient-centered have been the focus in all RSNA congresses over the last 5 years.
Both RSNA in 2012 and ACR in 2015 launched 2 patient-centered campaigns.
The RSNA Radiology Cares™ Campaign and The new American College of Radiology (ACR®) Commission on Patient Experience.
Both campaigns are designed to help radiology professionals optimize their patient’s experiences throughout their radiological care.
“Increased engagement helps improve your patient’s awareness and appreciation for the integral role you play in their healthcare.
In addition,
patient-centered practice enhances their understanding and comfort with their radiology tests and procedures and empowers them to make better informed decisions about their healthcare” (7,
8).
The European Society of Radiology (ESR) created a “Patient Advisory Group” (ESR-PAG) to address the issue of communication between radiology professionals (radiologists,
radiographers,
residents,
nurses,
administrators,
etc.) and their patients.
Initiated in 2013,
the group represents many patient groups,
working together with the ESR to raise awareness of medical imaging amongst patients,
improve patient knowledge about imaging procedures,
liaise on policy issues of common interest,
involve patient representatives in strategic decisions regarding medical imaging and ensure that a patient-centred,
“human” approach is embedded in the structure of the ESR (9,
10).
Other ESR initiatives saw the active contribution of patients.
During the Management in Radiology (MIR) 2013 meeting held in Barcelona,
patient representative T.
Szelagowski (EPF) gave a talk on “eHealth—patients’ perspective” and during a high level roundtable discussion on the “Role of Imaging in Personalised Medicine” organised by the ESR and the European Alliance for Personalised Medicine (EAPM),
which took place at the European Parliament in Brussels in October 2013,
the patients’ point of view was presented by patient representative Erik Briers,
Ex Officio Board Member of Europa Uomo—the European Prostate Cancer Coalition.
The Alliance for MRI,
founded by the ESR,
and including Members of the European Parliament (MEPs),
patient groups and the scientific community,
with the aim to ensure unimpeded access to MRI technology for all patients across the EU,
was successfully concluded in early summer 2013.
It serves as a good example for the importance of combined efforts between patient organizations and the scientific community.
The Spanish Society of Medical Radiology (SERAM) was permeable to all these initiatives and has also questioned how to increase visibility and to perform a more patient-centered radiology.
SERAM current president,
Dr.
José Luis del Cura stated:" For both clinicians and patients it is very important to know who is behind a radiological report. Modern medicine still requires radiologists who are present,
they can be consulted and whom clinicians can trust.
Physicians,
and patients should worry about knowing who their radiologist is " (11).