Medical Technology and Methodology: Putting the Radiography Patient at Ease - Essay Example

Putting the Radiography Patient At Ease Introduction In the last two decades we have seen a virtual explosion in medical technology and methodology yet the art of assisting the patient to be at ease during diagnostic procedures is lagging. Across all cultures, patients who must undergo diagnostic procedures have some level of anxiety that can be eased by the radiologists themselves. Honest communication (within the confines of professionalism) and empathy are paramount in this field, where some procedures can be invasive, painful or even considered intimate. Some solid theories regarding psychological/sociological training for radiology technicians have seen success; a broadening approach in regard to improving the technician-patient relationship to enhance compliance and satisfaction of the patient is seeing success in the field (Pawar, 2005). As health care professionals, it is imperative that we include good relations with our patients as part of our practice and to continue with our education in human relations in order to enable us to continue to stay in touch with the humanity of our work (The Independent, 2002). Quality of Patient-Technician Relationship: The Radiographer's Responsibilities Aside from setting up and working the machines involved as handling and submitting films to the doctors, we as radiologists must have a humanistic side since we work directly with patients. No one likes to have to undergo radiology in anticipation of a major illness or to see exactly what's happening 'where it hurts' after a fracture or rupture. Many times we are the first person the patient will encounter before major treatment is undergone. The patient will be experiencing some level of anxiety over procedures, preconceived ideas as well as worries of what comes after radiology, to name a few. It is our responsibility to assist in putting the patient at ease during the procedure, as much as possible. There are various ways of doing this; some of it is environmental, some educational and much is psychological. Whilst students of most disciplines of medicine receive only sketchy instruction in the art of psychological interaction, if a technician wants to be the best he or she can be, the patient's well-being must be the utmost priority. The Royal College of Radiologists' (2000) recommendations give instructions to enhance patient compliance and education as well as helping the patient to relax as much as is possible. Many of these recommendations are strictly clinical courtesy, but some offer suggestions for the communication prior to the procedure so as not to unnecessarily increase the patient's anxiety. Patient compliance is also of the utmost importance. When we must change the patient's position or take yet another image adjusting the dose, effective communication with the patient enhances compliance. The patient's dignity must be honoured at all times, and their comfort needs addressed as much as possible (Illingworth, Susan, 2004), But exactly how far should the we go to put their patient at ease Much of that depends upon the individual personality of the technician, but there are some common denominators that define adequate care from superior care (Code of Conduct Working Party, College Of Radiographers, 2002). We also need to be responsible for asking ourselves the proper questions in regards to our patients' and our own behaviour, whether potential or actual, such as this list (S. Michie, et. al., 2005): - Nature of behaviour ("what needs to be changed") - Knowledge and skills - Goal intention ("what to aim for") - Beliefs about consequences - Beliefs about own capabilities - Goal plan ("how to achieve change") - Environment-social - Environment-physical - Stress/emotion - "Other" The above list is a good reflective aid and if used thoughtfully, it gives us the ability to size up a situation before it can become a problem. We are not in private practice, nor do we have complete control over our environment. The above list, however, offers introspection for us and therefore enhances the ability to maintain a courteous, empathetic contact with patients rather than allow the erosion of it over time due to too much attention to the technical side of the profession. Continuing education in patient relations should go hand-in-hand with further training in technological areas. Though diagnostic radiologists and radiographers are not 'the cure,' we certainly need not be a negative part of the illness/injury. Ideally, the radiology team will have effective communication skills between them and will be able to transfer patient information smoothly. Quality images will be delivered promptly, any errors will be immediately corrected, and the machinery will be correctly maintained with regularity. Still, the patient should be the first priority (Royal College Of Radiologists, 2004). A Sample Psychological/Sociological Theories to Utilize in Practice According to Mazlow's Theory Of Human Motivation (1943), the psychological need for safety is one of the highest on the priority list. This is exacerbated when one (speaking of an adult) is ill or injured and at the mercy of others. In an incident that is extreme enough, the motivation of the individual degrades into simple survival, making our best intentions to communicate all but useless. In routine practice, the motivation of the patient is to recover health/mobility. Humanistic psychology and its branches are taking hold in modern Western society today as foundations for holistic patient care. In researching articles from several periodicals in this discipline it becomes obvious that medical practitioners are human and so are patients; they are simply in two different modalities of learning. Whilst humanistic psychology has been criticized as being too 'touchy-feely' by the British, some aspects of it are valid and should be taken into account a bit more, such as the concept of touch (Eve Siegal, 2000). It is said that a reassuring touch by the practitioner can be more useful than words, or can enhance the information being conveyed. This is not for everyone, granted. Yet it is still a powerful tool when putting a patient at ease, if the technician is naturally inclined to put a hand on the arm or shoulder whilst explaining procedure and equipment. Especially in the field of radiological practices such as mammography, contrast enema examination and defaecating proctography, scrotal, penile and perineal ultrasound and other such 'intimate' diagnostics, it is critical that we apply some form of humanistic psychology, as these patients can be extremely nervous and/or horrified about the procedures. Also what must be taken into consideration are the sociological factors at work in these procedures such as religion, culture, gender and preconceived notions on the patient's part. A good working knowledge of the many diverse cultures in our communities is critical; often we are prevented from performing our basic duties due to cultural barriers such as a male technician touching a woman whose culture forbids anyone but her husband to touch her in an intimate way. In these special cases, one must have a good knowledge of self and few Western theories will apply; this is a growing socio-cultural problem in Western society as we see more and more culturally diverse people in all fields of medicine including radiology. Behavioural psychology works well for many aspects of diagnostic radiography, especially when working with children. The simple system of offering a 'treat' (with consent of the parents) such as a lolly or a small chocolate or a sticker once the procedure is finished helps to create a feeling of trust and accomplishment on the part of the child. Qualitative psychology is labour-intensive in the field but a powerful tool when dealing with intense emotions. This branch of psychology is popular in the medical field, one of its most valuable concepts is to look to the meaning rather than the behaviour (Madill & Todd, 2002). Application of Theories In the Field Aside from the patient being the first priority for care, we as radiographers would be well advised to come to understand and practice relaxation techniques in order to maintain the mental clarity and composure under the pressures of an ever-changing profession. Meditation techniques have become popular in both traditional and complementary medicine and have proven themselves as a viable tool (Murphy & Donovan) With the plethora of psychosocial theories available, one can find and mould a good mix to use in practice. Often, we learn of an error after the encounter with the patient; one cannot know something until it is experienced; experience and continuing education along with keen human observation is an aid to achieving patient compliance, good relations with our medical team and patient satisfaction. Hopefully we as radiographers will continue to educate ourselves in regard to behavioural/cultural issues long into practice, in order to keep a fresh mind and enthusiasm for our chosen profession over time. Let us explore where certain theories can be applied under routine practices of diagnostic radiology: 1. The patient is afraid: Use of a combination of humanistic psychology and motivation can be employed, using the quality of empathy. Each of us has surely been afraid at some point in life and knows what it feels like. That we know the procedure, lack of risk and equipment thoroughly is irrelevant. The patient must be dealt with in a manner of patience yet not in a condescending manner (Radiography Careers website). 2. The patient is in pain: Since this is often the case, a combination of learned anatomy and psychology as well as compassion and empathy must be utilized. We must be good listeners and observers (Pawar, ibid.); some patients will be stoic and some will be hysterical. It is up to us to know when and how to assist in positioning and when to confer with a doctor for administration of medication. 3. The patient has a history of panic attacks (Dr. Joseph Smith Medical Library, 2005): This is where we come into our dependence on the team's level of responsibility; when the appointment is made and the patient has been screened, leaflets on self-care and relaxation techniques should be available for the patient to take home, read and practice. We should be informed if this problem exists in a particular patient. 4. The mammogram patient is concerned about the amount of radiation used for the procedure: Using the humanistic methods, we can address the concerns of the patient in such a way as to not make her feel isolated or afraid. Use of qualitative methods to compare the amount of radiation used in a mammogram to an everyday encounter with the same amount of radiation is helpful (Royal College Of Radiologists, 2005). Conclusion: Achieving Patient Compliance and Satisfaction The medical system is only as good as patient compliance will allow it to be. Since we are leading diagnosticians in the field with an enormous array of imaging technologies at our disposal, it is imperative that the patient's first encounter with us leaves a good impression and the willingness to return as needed. In the case of mammography, women are often reluctant to undergo this valuable screening procedure no matter how well they understand the consequences of late detection of breast cancer. Since we are the first contact in either a routine mammogram or a mammogram that is emotionally loaded with what the image will be, we should maintain professionalism and good communication skills that are empathetic and accommodating. The same holds true for other such 'intimate' imaging procedures as mentioned above. Patient compliance (the patient follows the doctor's orders for an imaging procedure and the patient's willingness to do what it takes for good images) is what keeps us in business as the front line of information in the medical field. Our conduct and 'people skills' are paramount in securing patient compliance in the cases of routine or follow-up procedures. Are compliance and satisfaction the same No. Following compliance must come satisfaction, and this is dependent upon the skills of the radiologist during all phases of the imaging procedure. If we are brusque, too clipped, impatient or distracted, patient satisfaction is less likely to occur although compliance (showing up in the first place) did occur. A friendly and reassuring environment can be made, demonstration of true concern and techniques for enhancing mental well-being are all within our reach. Works Cited http://www.aers.org/v1n1jordan.html Pawar, Manoj MD, MMM (June 2005), 'Five Tips for Generating Patient Satisfaction and Compliance,' Academy Of American and Family Physicians: News & Publications |Online| Available at: http://www.aafp.org/fpm/20050600/44five.html CLINICAL RADIOLOGY PATIENTS' LIAISON GROUP (2000), 'Making your Radiology Services more patient-friendly,' The Royal College of Radiologists (Leaflet publication) |Online| Available at: http://www.rcr.ac.uk/index.aspPageID=310&PublicationID=73 Code Of Conduct Working Party (January 2002), 'STATEMENTS FOR PROFESSIONAL CONDUCT,' College of Radiographers, |Online| Available at: http://www.sor.org/public/pdf/profcond.pdf Faculty of Clinical Radiology (2004), 'Individual Responsibilities- A Guide to Good Medical Practice for Clinical Radiologists,' The Royal College of Radiologists |Online| Available at: http://www.rcr.ac.uk/index.aspPageID=310&PublicationID=193 Illingworth, Susan (2004), 'Ethics: QAA Benchmark Summaries,' The ETHICS Project, |Online| Available at: http://www.prs-ltsn.leeds.ac.uk/ethics/documents/radiography.html The Independent (02 June 2005), 'Meet People and Look Inside Them,' |Online| Available at: http://jobs.independent.co.uk/careers/story.jspstory=643261 Madill, Anna & Todd, Zazie (September 2002), Proposal to the Council of the British Psychological Society for the formation of a new Section of the Society on 'Qualitative Methods in Psychology,' School of Psychology, University of Leeds |Online| Available at: http://www.psyc.leeds.ac.uk/research/qual/BPSQualSection.pdf Mazlow, A.H. (1943), 'A Theory of Human Motivation,' Originally Published in Psychological Review, 50, 370-396, posted online August 2000 by Christopher Green. Available at: http://psychclassics.yorku.ca/Maslow/motivation.htm Michie, S., et.al., on behalf of the 'Psychological Theory Group (2005), 'Making psychological theory useful for implementing evidence based practice: a consensus approach,' QSHC Online, Available at: http://qhc.bmjjournals.com/cgi/content/abstract/14/1/26 Murphy, Michael & Donovan, Steven, 'Chapter 2, Physiological Effects,' The Physical and Psychological Effects Of Meditation, Institute Of Noetic Sciences, 1999-2004 |Online| Available at: http://www.noetic.org/research/medbiblio/ch2_1.htm Radiography Careers website: 'What Makes a Good Radiographer' |Online| Available at: http://www.radiographycareers.co.uk/whatgoodrad.html Royal College Of Radiologists (2005), 'Commonly Asked Questions in Radiology' |Online| Available at: http://www.rcr.ac.uk/index.aspPageID=504 Siegel, Eve (2000), 'Staying In Touch With Touch.' AHP Perspective, June/July 2000 |Online| Available at: http://www.ahpweb.org/pub/perspective/touch.html Smith, Dr. Joseph F. Medical Library (30 August 2005), 'Anxiety,' The Thompson Corporation, |Online| Available at: http://www.chclibrary.org/micromed/00038160.html Southern Area Health Authorities (UK), 'Cultural Handbook For Staff,' |Online| Available at: http://www.shsscouncil.net/pdfs/Cultural%20Handbook%20-%20Partners%20PDF%20File.pdf. Zalaquett, Dr. Carlos P. & McCraw, Angela (2000), 'About Relaxation,' exerpted from Clinician's Complete Reference to Complementary & Alternative Medicine by D, Novi) |Online| Available at: http://www.coedu.usf.edu/zalaquett/relax/About_Relaxation.htm Read More