“Your report will be ready in 24 hours. Enjoy the rest of your day.”
“Okay, but what can you see?”
“Uh…”
Time to have The Talk with the patient.
Introduction
We’ve all been here. I think it is one of the most common causes for explanation in the profession, yet it is not talked about enough. Over time the Radiographer just figures out the response that works best for them and sticks with it.
You have to walk the patient through the fact that there’s someone else behind the scenes who is trained to look through the images you’ve just acquired and give a detailed report taking their medical history and other relevant factors into consideration.
But how can you do that without seeming like you’re just choosing not to tell them, or you’re not empathetic, or worse still, like you’re belittling yourself?
Background
The truth is that some of the time, that patient or patient relative asking knows that they’d get the interpretation in a report, but a good amount of the time, they don’t. So you need a one fits all kind of response that makes every category of patient understand that whatever curiosity they have will be answered, not by you, but by the Radiologist, in their report.
Another very interesting truth is that you should actually be able to understand the image you just acquired, especially in cases where something significant is to be seen. That would determine how much more views or sequences to add or remove from your total examination lineup. It would also be crucial in cases where there’s an unknowing emergency.
To understand how to respond, as in all cases of good communication, you have to understand the basis of the question. Here are some possible reasons why the patient would want to know what you see after their scan or X-ray:
They do not understand the normal process and are innocently just trying to see if they can get a sneak peek of what their eventual reports will contain. In my experience, patients like this are the easiest to explain to. Since you’re introducing the normal process to them, they’re usually more compliant and tend not to probe further. However, it is important to present your response as professional as possible as the conversation with you will be their introduction to the regular Radiology department workflow and any flaw in your explanation will give them the wrong perception from the onset.
Some patients know the normal process but they’re just harmlessly curious. These patients just ask the question in passing and sometimes don’t expect feedback. This does not mean you shouldn’t give feedback. Always give feedback. They use statements like “I hope my X-ray is alright” “I hope nothing is wrong with my brain.” in a bid to get you to point out the negatives, if any. These patients want to get ahead of any negative possibilities with any information they can get from you. Even if you don’t see any negative possibilities from their images, it is advisable not to interpret it as fine to them. In healthcare, even the slightest bit of inconsistency can unsettle the patient. If you immediately say “Yes, your X-ray is alright” or “Nothing is wrong with your brain”, you give only one outcome for the report, and in that case, you might as well be the one reporting it, because once the report goes against your quick response, you immediately lose all credibility in the sight of the patient and/or their relatives.
Some patients or patient relatives ask what you see because they’re desperate. They’re having cancer recurrence scares, they’ve just had a bad accident, their loved one just had a stroke, or they’re doing that scan to confirm a diagnosis they’re absolutely terrified of. They make statements like “How bad does it look?” “Can you see any tumour?” or even “Am I dying?”. They are usually very persistent and this is a very valid reaction to their circumstances. But what does that mean for you, the Radiographer? You should understand how sensitive the situation is and how much every word you say means to the person listening. It is imperative that you do not start disclosing your own interpretation of the acquired images as this is not only unprofessional, it is clear exploitation of the patient or relative’s vulnerability. It is super sensitive in that they will very likely cling to your “diagnosis” and start readjusting their reality around what you just said.
If the report contains anything different, you would have made them readjust their reality only to have to readjust again, and it’s very unfair to do that to anybody. Health is a factor that affects life directly and it is too sensitive a factor for anybody to have emotional rollercoasters about, especially since the emotional rollercoasters could lead to worsening health.
But now that we’ve established the fact that you shouldn’t disclose your on-the-spot interpretation of the images to the patient outside the scope of emergency escalation and study expansion, how do you communicate that fact to the patient and get the patient to understand you?
Let’s follow the train of communication…
Patient completes examination (focus: patient).
You let them know when their report will be available (focus: report).
They ask, “What do YOU see?” Now the focus is on you.
What do you do to get the focus away from you and back to their report or the management of their case?
What I Do Not Recommend
Firstly, let’s look at the responses I do not recommend, and why.
I cannot…
“I cannot say what I see.” “I cannot see anything.” “I am unable to tell you what I see.”
It’s usually followed by statements like “My job is just to take the images, and then the Radiologist reports.”
This is a perfectly normal response to the situation, and with a very calm tone and expressive body language, you will have passed your message very well. But what message did you just pass? And what did you do to the focus of the conversation?
You just let a patient leave you with the thought that the Radiographer doesn’t know anything beyond just taking pictures, or the Radiographer cannot do anything helpful for them after taking the images.
Is any of that true? No!
You also still kept the focus on you, but more notably, what you CANNOT do.
I should not…
“I shouldn’t say…” “I’m not at liberty to say…” “I am not supposed to tell you…” “No comment…”
This is usually followed by things like “It’s not my place to tell you. You will get a more detailed explanation in the report and your doctor will properly explain everything to you.
This kind of response can be curiosity inducing.
“Oh my God, what is so bad in my MRI that he’s so afraid to tell me?” “Is the issue that bad that she’s refusing to say?”
The choice of words in this kind of response let’s the patient know that while you can, you will not tell, and in many cases, they can attribute it to the gravity of what you can see, or your sheet reluctance to actually help.
Also, this kind of response highlights what you SHOULDN’T do, and doesn’t draw the patient back to their report and the management of their case.
I am not trained to…
“I am not trained to interpret.” “I am not qualified to read the images.” “I am only trained to get images, not to read them.”
This usually comes before statements like “…but the report will be written by a Radiologist, a doctor who is trained to go through your images and give a valid report.” Or “The Radiologist is a trained professional that writes the report, whatever I see might contradict what the report says.”
The question is… Do they have to know all of that?
In my experience, in a hospital, the more deficient the patient feels you are at anything, the less comfortable they are with you. While it is true you aren’t expressly trained to interpret reports and give reports, the Radiographer is trained to understand every aspect of the images they acquire, including the different appearances and their significance. This means that you’re not doing yourself justice by highlighting something you’re not trained to do in your response.
You are letting the patient feel like you don’t even have any idea of what the images entail since you lack the necessary training, even though you’re the one acquiring it. That’s just untrue, or at least it should be. Also, you’ve kept the focus on yourself, highlighting your lack of training in an area they currently need.
Ignoring the patient or responding rudely.
Now this goes without saying, but it needs to be addressed. The Radiography profession is still understaffed and the average Radiographer has a very busy workday, so it is understandable for you to be reluctant to go over the same response for the 17th patient in one day. But you absolutely have to, and it is advisable to do it empathetically and professionally.
I acknowledge the fact that all the responses addressed above may not give a direct negative impression on the patient or their relatives. However, I do not recommend them because they give the possibility of a negative impression and that is something to guard against.
What I recommend.
In my experience, here are the solutions I have tested and gotten good feedback from so they currently work for me 9 times out of 9.
Firstly, it is advisable to listen carefully to the patient and let them finish before you talk.
The main point of your response should be to get them to wait for the report, reassure them of the quality of the report (basically why it is worth the wait), and immediately take yourself out of focus. Now, let’s explore options.
“Getting a good report involves taking time to go through the images carefully, and that’s what our Radiologist does. I’ve sent them your images and they’d provide a comprehensive report based on their findings and your medical history. Don’t worry, I made sure to get the required images they’d need to give a well detailed report.”
In this, you’re not talking about what you cannot do, or aren’t trained to do, but about the report, the right process, and what you did right.
“I made sure to get the best quality images and I have sent the images to the reporting end, which is more detailed and has all the tools needed for accurate reporting. On that end, there is a specialist doctor, the Radiologist, who goes through the images carefully and gives a comprehensive report.”
This highlights the quality of the images acquired and let’s them in on the significant work that goes into giving them a good report without referencing the liberties and ability of the Radiographer.
For cases with larger image quantity, you can also reference that in your response as follows:
“Typically, MRIs involve taking hundred or even thousands of images which need to be carefully scrutinized to give an accurate report. We have specialist doctors who view the images using software with special capabilities different from this (referencing the console) to get the best quality report for you.”
This also highlights the process and lets the patient understand the need for the scrutiny, as opposed to a quick look-and-tell which they are requesting. It also reinforces the impact the right process will have on the quality of the report.
It is important to note that all the recommendations should be accompanied with a courteous and professional attitude to properly drive home your point. It is advisable to make them understand that their wait for the report is helping them and not doing the opposite.
In conclusion
Imaging reports are highly sensitive, and it is important to consider that before responding to even the most persuasive patient/patient relative about what you see in their/their relative’s images. When responding, focus less on what you cannot or should not do, and focus more on the need for them to follow the right process, highlighting the advantage that will have on their report.
References
I wrote this article with input from about 50 Radiographers across 3 different countries and I really appreciate every single one of them that gave me their time and input.