MILWAUKEE, WI—Ian Weissman, a radiologist with the Milwaukee VA, can trace his desire to be a doctor back to one source. “I grew up watching ‘The Waltons.’ There, the primary care doc was part of the community,” he explained. “That was my dream.”
But after he completed his residency in internal medicine, he found that his dream clashed with medical reality. “Nowadays, primary care docs only have a few minutes to see their patient. I didn’t feel I was able to make the connections,” he pointed out. Having done a rotation in nuclear medicine, Weissman found that radiologists were able to devote more time to each patient’s case and, as a bonus, they got to play with all the latest imaging technology. Tired of rushing through patients, he eventually transitioned to radiology.
But once there, he discovered that radiologists were starting to face the same challenges as primary care physicians: less time for patients and less direct connection to the care team. Weissman remembers when radiologists were considered “the doctor’s doctor.” They were the physicians that internal medicine doctors consulted when they wanted to interpret an image. Does this appendix look swollen? Does my patient need surgery?
With the rise of technology that allows medical imaging to be viewed anywhere in the hospital, radiologists have found themselves slowly becoming isolated. Rarely do physicians ever visit radiology for a consult—not when they can pull up the results on a tablet. And rarely do physicians have the time to make such a consult. Patient workloads have risen, and the time for face-to-face consultation has dropped in proportion.
The days of the regular face-to-face consult might be gone, but Weissman and the American College of Radiology (ACR) are doing their best to bring radiologists out of isolation. This time the goal is not to make radiologists the doctor’s doctor, but the patient’s doctor: a member of the care team whose value patients recognize and with whom they can communicate.
Several years ago, the ACR kicked off Imaging 3.0—an initiative to transition the practice of radiology from volume-based care to value-based care. Instead of asking how many patient scans can be analyzed in a day, radiologists are asked to question how they can best provide value to the patient. As part of Imaging 3.0, ACR formed the National Commission on Patient and Family-Centered Care (PFCC), of which VA is a part. The goal of the commission is to ensure that radiologic care is provided in a way that incorporates patient needs.
“Hippocrates talked about the importance of talking with the patient,” Weissman noted. “But PFCC didn’t evolve into the form we’re seeing now until the late 1980s. How have we done medicine for all these years? If you collaborate with a patient, things work better. It still seems that this is an epiphany for a lot of people. But this should be bundled into healthcare. It should be part of who we are.”
Part of the commission’s mission is to provide resources and tools that will teach radiologists and hospital administrators how to engage with patients and families and communities. This includes developing new technology and platforms to improve that communication.
For example, with the ability for patients to easily download their own medical charts, radiologists’ reports are being pored over by patients. However, those reports have historically been written for other physicians who have a much more robust medical lexicon.
“Patients finally have access to the reports. It empowers them and gets them involved,” Weissman explained. “But they get this report, and it means nothing. Radiologists have a language like other specialties, so it’s a bunch of words and the patients don’t know what they mean.”
The commission is researching ways to help patients understand those reports they’re downloading. “We’re still in the early stages, so we’re looking at a variety of fixes,” Weissman said. “One possibility is to give an alternative report, one in simple prose that a patient can understand. Another alternative is to use hyperlinks to definitions and explanations.”
Weissman is the chair of the commission’s Toolkit Subcommittee. The toolkit is a collection of resources for hospitals looking to improve PFCC at their facility. From how to begin recruiting partner providers to data collection and program evaluation techniques, the toolkit is designed to make the transition to more patient-centered care less daunting.
“We broke the toolkit into five categories: hospital, children’s hospital, private practice, academic and VA. Just click the link and it takes you to a whole bunch of resources and examples of how to be more patient-centered and family-centered.”
The biggest barrier, Weissman noted, isn’t the lack of training or resources, but the culture of individual hospitals. “You need a culture in your hospital that’s supportive. If you don’t have that, it won’t happen.”
Improving PFCC at a facility doesn’t always require huge administrative steps, Weissman said. For years now, he’s been conducting what he calls “Hello Rounds.” Whenever he sees a patient on a stretcher in the hallway of the radiology department awaiting care, he stops to greet them and see if there’s anything he can do for them. It’s a small step, but one that can have a profound impact on patients who might feel that they’ve been forgotten amidst the hustle of a busy hospital.
“It makes a big difference,” he said. “I feel more connected. They feel more connected. Sometimes they want to talk for a few minutes. It doesn’t really affect my work flow at all.”
In effect it brings a little bit of the spirit of Walton’s Mountain to the halls of the VA.