There are occasions when we decide to image a patient. Sometimes the decision is made at the bedside, and the patient is informed that they need ‘a scan’. On other occasions, the decision is made away from the bedside.
Often the most junior doctor on the team is told to book the scan by their senior and, after requesting, the scan is accepted, protocoled and scheduled by the radiologist.
"Does the patient know they are coming down for a scan?"
I once got asked by the duty radiologist: "Does the patient know they are coming down for a scan?". The question was initially puzzling, as it seemed to have an obvious answer… but do we always inform patients appropriately of decisions around diagnostic imaging?
Lack of communication between the referring doctor and patient becomes more evident when the patient arrives in the radiology department to have their scan (1). Radiologists and radiographers undertaking the imaging have most likely never seen the patient before. The only information they receive are a few sentences (if they are lucky) on an electronic request form.
There are occasions when patients would question the reason for imaging, or are puzzled by their arrival at a new department, but by that point they are surrounded by clinicians who were not involved in the original decision process and may not have access to the relevant information needed to answer the patient's queries (1).
Patients may not have been told the purpose of the referral to the radiology department. We can't assume they would know the difference between scans or assume they would prefer a certain imaging technique to another. Adding to this, there are reports of patients expressing their anxiety when arriving to the radiology department and questioning whether there are alternative means to reach the diagnosis (1).
'Requesting scans' by Unicyclemedic at unicyclemedic.com
It all starts at the bedside, where providing time for an open discussion about imaging can lead to a better understanding for the patient, and a more thorough decision on whether the patient wants to undergo a scan.
This preparation plays a crucial role in patients’ expectations and how they ultimately experience the scanning procedure (2). For example, a patient is picked up by a porter and informed they are going for a scan, they then arrive at the radiology department. New faces, new equipment, new sounds. This can all be daunting, especially if we skip the first step in the patient’s journey, when we provide crucial information about imaging.
Ultimately it can lead to a sense of lack of control and eventually anxiety, which has been found to lead to discomfort during imaging and a negative experience (2). Psychological preparation is a key factor in the experience of a patient and it is important to remember this as clinicians ordering investigation.
Once we become aware of this and accept the need for change to our approach, we can start communicating investigation options to patients and having a patient-centred decision making process. We need to bear in mind how we inform patients of the need for imaging and how it will help manage their symptoms. We may be able to quite impressively list all the possible diagnoses to our seniors, but when our list contains the words ‘malignant’ or ‘cancer’ we need to allow time for the information to be digested. Often patients do not hear much of what we say following the word ‘cancer’ and can block out a lot of other important information (3). Therefore ensuring that we improve our practice requires us to dedicate time.
Combining a busy ward job with the increasing pressure to provide imaging to patients makes it challenging to provide adequate time to have this discussion. It's evident from studies that there can be a lack of communication between the clinician and the patient, primarily because patients feel doctors are rushed (1). It is easy to become focused on ward tasks that need to be completed in a limited time and leave more challenging conversations until after other jobs are complete. Conversations regarding imaging can subsequently feel rushed.
"Discussions around diagnostic imaging tests should not be viewed as yet another job that we need to do, but a core part of good clinical care"
Discussions around diagnostic imaging tests should not be viewed as yet another job that we need to do, but a core part of good clinical care. We should be reminded that the patient is the most important member of our team.
- Makaniee, CR, Bergh, AM, Hoffmann, WA. 2015. Healthcare provider and patient perspectives of diagnostic imaging investigations. African journal and primary healthcare and family medicine. 7(1):801.
- Carlsson, S. 2013. The situation and the uncertainty about the coming results scared me but interaction with radiographers helped me through’: a qualitative study on patients’ experiences of magnetic resonance imaging examinations. Journal of Clinical Nursing. 22(21-22):3225-3234.
- Itri, J.N. 2015. Patient-centred Radiology. RadioGraphics. 35(6).
This post was written by Dr Margarita Lymbouris, an FY2 at Norfolk and Norwich University Hospitals (UK) at the time of publishing.
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