How do you deal with anxious patients undergoing a stressful radiological procedure, such as an MRI scan, or something more painful like a breast biopsy? Many patients feel terrified at the prospect of being on the receiving end of the marvels of modern technology. Fortunately, there’s one approach I’ve seen, based on hypnosis, that has been shown to improve patient comfort in multiple clinical trials.
Interventionalist Elvira Lang has begun to train other radiology professionals including technologists, nurses and physicians in her method of non-pharmacological patient sedation. As a former Harvard faculty radiologist, she is the lead author of over two dozen research papers documenting a reliable way to reduce claustrophobia in MRI, anxiety in mammography and pain in interventional procedures.
As a musculoskeletal radiologist, I’m used to injecting a local anesthetic prior to performing an arthrogram. Unfortunately, as residents we were taught to say it will “feel like a little bee sting and then it will burn,” which are both negative suggestions and self-fulfilling prophecies. After training in hypnosis more than 20 years ago, I learned to simply say, “I am injecting the numbing medicine that will cause a sensation under your skin and notice how quickly it gets numb.” The language makes all the difference.
My most challenging patient spoke only Spanish. He had complex regional pain syndrome, and I had to do an arthrogram on his sensitive ankle. I asked him through his interpreter, “Where would you rather be?” He said his favorite restaurant, and I suggested he go there while I did the procedure. Ten minutes later we were done without any mention of pain as he had been busy eating a delicious five-course meal.
These kinds of experiences amazed all of us in the radiology department at Duke University Medical Center as described in my book Let Magic Happen: Adventures in Healing with a Holistic Radiologist. Similar reports came in from other grateful patients that Lang worked with at Harvard, and she did research to prove that radiology personnel could be team trained in communication skills to improve patient outcomes. She elaborates on the power of language and other methods in her book Patient Sedation Without Medication.
Patient satisfaction has become more important to hospitals since the implementation of the Affordable Care Act. These ratings have a significant impact on the up to 1 percent of reimbursement that is now withheld by the Centers for Medicare and Medicaid Services through the Hospital Value-Based Purchasing Program. It’s possible that up to 30 percent of the money can be recovered through improving patient satisfaction metrics.
A recent paper by Lang demonstrated that team training in communication skills, with a targeted focus on rapport, relaxation and reframing of patient distress, has the potential to greatly improve patient satisfaction in MRI. This approach has also been shown to save time and money while decreasing the use of medication (and the associated side effects), a benefit for patients, staff, and administrators.