Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Patient-Centered Care: More Than a Platitude

Finding out the real reason we should make time for in-person patient consultation

This week's guest blogger is Arun Krishnaraj, MD, MPH, from University of Virginia. Listening to him describe a recent interaction with a patient, I couldn't help but keep circling back to one key word he uses: "connection." We as physicians should not aim simply to transmit information, dispense diagnoses, or spout instructions. We need to connect with patients around their health. And that's what Dr. Krishnaraj is here to tell us about today.

Organizing care around the needs and values of a patient rather than those of a physician has become a popular mantra among health policy wonks. If you do this, we are told, our health system will be more compassionate, safer, and more cost effective. And, perhaps most importantly, these measures will help us provide better outcomes for our patients. So how, you may ask, do we pursue patient-centered care in radiology and what does it look like?

The Institute of Medicine defines patient-centered care as "providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions." The patient experience of care is a central tenet of the so-called Triple Aim, in which care comes before health and cost.

So how do we operationalize the process of transforming care in radiology? Our specialty has historically been organized around radiologists' workflow, so it's a shift to place the patient at the center. In a recent article, Jason N. Itri, MD, PhD, provides an excellent overview and conceptual framework for what constitutes patient-centered radiology. He highlights many overlooked aspects of radiological care that could be improved to create a more patient-centered environment. Some of those items include communicating effectively, adequately managing pain, addressing patients' emotional needs, and supporting family involvement.

I've seen the value of being patient-centered in my own practice. Last week, I met with a middle-aged gentleman patient and his wife in my office to discuss the results of a recent liver MRI. His colorectal cancer had unfortunately metastasized to his liver and lungs. In the lead-up to this meeting, I exchanged many emails with him, answering questions about his studies. He wished to see me in-person with his wife and go over his images. I set up the meeting in my office and reviewed all his prior imaging studies, explaining the results and reviewing his images. The personal connection helped my patient and his wife better understand his condition. It was also very gratifying for me as a physician. After our meeting, I received a heartfelt thank you note and small token of appreciation. I realized the impact the encounter had on my patient and his experience in our health system.

Many radiologists think of their customers as their referring providers. But during an era in which patients are reading their own reports, patients want to speak directly to the doctor who interpreted a study they know to be critically important to their care. While this type of encounter does not result in any additional reimbursement, it does improve our standing among our most important customer, our patient

If we are truly to become patient centered in radiology, we must break down the traditional barriers that exist between patients and radiologists. We must empower our patients with knowledge and give them greater control over their imaging care by incorporating their needs and preferences. This is often best accomplished by meeting directly with our patients. 
While many obstacles stand in the way of this type of interaction, the simple truth is that patients are asking to hear about their health directly from their physicians. Why should all patients be given this option? Because they deserve it.​

Many thanks to Arun Krishnaraj for his contribution to the JACR blog. What does patient-centered care mean to you? Are your experiences similar to Dr. Krishnaraj's? What steps are you and/your practice taking to enhance care delivery and patient experiences? Do you think referring providers appreciate radiologist direct-to-patient consultation efforts or do they see it as overstepping? Does the current lack of reimbursement act as a disincentive to build a consultation service? What barriers to providing patient-centered care exist in your practice? I hope you will share with the JACR community in the comment box below.

Additional reading and resources about Patient-Centered Care:

ACR Patient- and Family-Centered Care Resources - including JACR articles: "Rethinking the Patient Experience" series, "Professionalism: The Patient's Perspective", and "Improving Patient Care Through Inspiring Happiness"

ACR Patient- and Family-Centered Care Commission 

Dr. Krishnaraj is the director of the division of body imaging, section chief of abdominal imaging, and co-director of body procedures at the University of Virginia. He currently vice chairs the Informatics Committee under the ACR Commission on Patient- and Family-Centered Care. You can follow him on twitter @AKrishnarajMD.

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Tuesday, 23 May 2017

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