Each year, Diagnostic Imaging pays tribute to radiologists who have made an indelible imprint on one area of the industry. This year, we focused on contributions to improving patient experience.
Here, DI speaks with Lawrence Bassett, MD, retired radiology professor at the David Geffen School of Medicine at the University of California at Los Angeles, about his efforts to improve patient experience throughout his career.
DI: From your perspective, why is it important to concentrate on improving patient experience?
Bassett: It’s practical in radiology today. Many are experts in specialized fields, and they may be the best ones to talk to the patient when they have questions, especially about their imaging. For example, in breast imaging where I worked, the patient may have questions that the referring physician might not be able to answer. We found that referring physicians asked the patient to talk to us about their questions. That was quite a change because when I first started in breast imaging, the referring physician didn’t want us to talk with the patient — they would get very resentful. Early on, I had a patient with an abnormal mammogram who had questions. I told her she would need a biopsy, and later that day, the referring physician called me back and was angry. That was the 1970s and 1980s. By the 1990s, referring physicians were actually thanking us for tackling patient questions.
DI: What would you point to as the highlights of the work you’ve done to improve patient experience?
Bassett: , I did some research on all of this because I moved from musculoskeletal radiology where we rarely talk with the patient to breast imaging where it’s become common to talk with the patient. We saw it depends on a lot of different things. One of them was that we were doing, by the 1990s, biopsies with needles, including fine needle aspiration and core needle biopsy. Prior to that time, it was almost all done in surgery. So, there was a major change there, and we had to learn how to deal with that change. We did explain it to the patient. We had to explain to them the accuracy of the core needle versus the surgical route. As it turned out, they were very accurate. Core needle biopsy was very good at finding the correct diagnosis. Sometimes, more information needed to be obtained, then, they would undergo surgery. But, most of the time, the core needle was performed for the diagnostic mammographies and ultrasounds for any abnormalities. The patient needed to be told about what the biopsy was like and what happens. They had to feel comfortable that the answer was reliable. That was part of what we had to report to the patient. We became consultants as time went on for referring physicians because they were depending on us to talk to the patient about findings.
When a patient comes in with abnormal findings, detected either by the referring physician or by themselves, they come in for a diagnostic mammogram. When they come in with a referral for a diagnostic mammogram where there is an abnormal finding, we’ve found it’s best that one of our radiologists talk with the patient before she leaves. We look at the image, decide what to do next, and talk with the patient. Referring physicians didn’t know how to do that, and they depended on us. Things changed over time. After the 1990s, I think most physicians wanted us to talk with the patient if they had abnormal findings on clinical exams.
DI: What has been the impact of and benefits of your work?
Bassett: I think for one thing, the patient felt more comfortable with the diagnostic process. Before they left after their work up, we would talk with them, explain what we found, and what they should do next. Many times, we could tell the patient not to worry, but other times, we had to discuss findings that are most likely benign but that could require more surgical intervention.
I think, clearly, the patients were happy with this kind of follow-up and help. The referring physicians liked it a lot because they didn’t know how to explain those findings to the patients or decide what needed to be done next as part of the work up. I think this has sped up care and made a very close team among the referring physician, the patient, and the radiologist.
DI: As a field, from your experience, what should — and can — radiology do to improve the patient experience overall?
Bassett: One thing is to be sure that your own radiology team, which includes the radiologist, the person who receives the patient when they arrive, and the technologist, should all be aware of the importance of how to talk to the patient. What things should they say and not say? We worked closely with the techs on that. We also had a fairly large patient volume, and a trained person in our section that would help make appointments and set up biopsy times, and take their phone calls because we were often busy. We depended on this individual to know when to have us intervene and when to explain the findings to the patient. He was so helpful, and the patients always mentioned him and talked about him all the time. It took pressure off of us. He was a liaison to other offices and would call them on the phone and set up appointments and answer questions they had.
One of the things we did for a while during research was working with psychologists to understand the psychological effects patients experienced. We weren’t aware of that, but we studied why they were anxious. That’s important to know in case we have to try to calm them down. Occasionally, we have Valium for some patients, but usually we don’t have to use that. Biopsy is just a major thing to consider, and I think having a warm environment and a group that works well together was important for us.