Providing the Best Care for our Patients

Geraldine McGinty_MGF1866Geraldine McGinty, MD, MBA, FACR, chair of the ACR Board of Chancellors, contributed this post.

As physicians, our goal is to provide the best care for our patients. How can we deliver?

As I mentioned during the #WeAreRadiology session last week at RSNA 2019, it’s only when our patients bring their experiences and ideas into the room that we can work together to help design health care systems that work for them. If our work revolves around the care of patients, why aren’t we putting their needs and ideas at the center of our work?

Recently, during a conversation with Neil M. Rofsky, MD, MHA, FACR, he shared with me the stories of two physician colleagues at UT Southwestern Medical Center who have embodied this principle: Rising Star Award honoree David Fetzer, MD, and Patient and Family Recognition Award honoree Daniel Costa, MD.

Dr. Fetzer’s work includes developing new service lines to help transform the perception of ultrasound imaging and intervention. He has championed the use of contrast-enhanced ultrasound to more accurately diagnose patients, allowing physicians to more effectively tailor their treatment decisions for patients.

Dr. Costa excels at the intersection of diagnostic skills and direct patient care. He has also proven himself to be a consummate team player with colleagues, referring providers, patients and their families. His colleagues say he is known for treating every patient like family, ensuring that they – and their caregivers – feel valued and comfortable, and that their questions, concerns and feelings are heard. Dr. Costa played a critical role in establishing one of the top prostate cancer programs in the country.

Though each of us may play different roles in our departments and organizations, one thing is clear— building a constructive relationship between providers and patients creates the foundation for high-value care. Like Drs. Fetzer and Costa, we ought to set the standard of care for not only radiology, but also for our institutions – and medicine – as a whole. The need to provide care in collaboration with our patients so that we can meet their goals underpins the work of the American College of Radiology® (ACR®)’s Commission on Patient- and Family- Centered Care (PFCC).

How do you provide PFCC in your practice? Is it time to make a change? The ACR provides several resources for physicians who want to implement PFCC and take your patient-centered care to the next level.

  • How are you and your colleagues working to improve PFCC in your practice? What tools or techniques have worked best for you?

Please share your thoughts in the comments section below, and join the discussion on Engage (login required).

Safeguarding the Future of Radiology

Dayal_AnupriyaAnupriya Dayal, MD, radiation oncologist at Temple Health-Fox Chase Cancer Center and Pennsylvania delegate, American Medical Association Resident and Fellow Section House of Delegates, contributed this post.

As a member of the American Medical Association (AMA)’s Resident and Fellow Section House of Delegates (HOD), I recently attended the AMA Interim Meeting to help represent the views and perspective of radiation oncologists like myself. The HOD is the AMA’s policy-making body and is made up of a diverse group of physicians, medical students and residents representing every state and medical field. We work together in a democratic process to create and implement policy on various health care conflicts to ensure safe, high-quality and efficient care for patients and communities around the country. Our recent meeting focused on the protection of residents and fellows displaced by unexpected hospital closures and radiation oncology safety measures.

The Hahnemann hospital closure earlier this year was an unexpected event that disrupted the training of 960 resident and fellow physicians. There were no safeguards in place to protect affected residents and fellows. As a result, trainees were left unsure of the future of their careers. On top of that, the incurred relocation costs – added to an average debt of around $200,000 – have left many in an unexpected financial strain.

The AMA, along with the AMA Resident and Fellow Section coauthors, intervened to help find a solution for these residents and fellows. Our new policy allows us to partner with interested parties to identify viable options to secure malpractice tail-end insurance for residents and fellows impacted by the Hahnemann closure and for those impacted by any future teaching hospital closures, at no cost to those who are displaced. We’ve also committed to working with the Centers for Medicare and Medicaid Services to establish regulations that will help protect residents and fellows affected by training program closures.

Additionally, we discussed the recently released CMS Hospital Outpatient Prospective Payment System final rule, which includes a provision to change all radiation therapy services from “direct supervision” to “general supervision.” This rule is supported by the misguided notion that radiation therapy can be administered without the presence of an MD and is a glaring safety and scope of practice issue.

Radiation oncologists are the only medical professionals trained in reviewing toxicity of treatment, daily patient setup variability, real-time imaging interpretation for accurate radiation guidance and other clinical parameters which determine the safety of further radiation treatment administration. Our role is critical to ensuring safety in delivering high doses of radiation that may otherwise be fatal without supervision. As such, the AMA provided convincing testimony to encourage reconsideration by CMS.

As physicians, we are compelled to be advocates for not only our profession but also – and more importantly – for our patients. As radiologists, we provide expertise not only to other health care professionals, but also specialty-specific health policymaking. Membership in the American College of Radiology and the AMA help ensure that we have a seat at the table of health policy discussions that impact both our daily work and the future of medicine.

Please share your thoughts in the comments section below, and join the discussion on Engage (login required).

It’s Time to Ditch the Disk: On Cancer

Rand, AlexAlexander Rand, MD, University of Vermont, and Michael Chorney, MD, Penn Medicine, University of Pennsylvania Health System, contributed to this post.

Opinions are the authors’ own and do not reflect their institutions’ opinions.

Imaging is critical for the detection and evaluation of cancer. Cancers manifest on dedicated screening and diagnostic studies as well as incidentally on other studies. Tumors may change in size, distribution and enhancement pattern during treatment, which directly impacts treatment decisions. Radiologists must be able to assess cancer’s complex evolution over time on imaging to provide the best patient care. Unfortunately, health care’s current reliance on compact discs (CDs) for image transfer often leaves radiologists without prior examinations for comparison.

Cancer screening imaging enables early detection and prompt treatment to reduce patient mortality. Radiologists strive both to detect cancers and discriminate between benign and malignant masses or nodules. Some cancers, particularly breast cancers, may only become apparent with subtle changes in size and morphology over time. Long-term stability of a mass makes cancer less likely. If suspicion for cancer remains very low, or biopsy carries high risk for morbidity, follow-up imaging can help determine if intervention is warranted. However, patients often forget to bring their CDs or discover that the images are missing or corrupted. When prior images are unavailable, the radiologist may be compelled to recommend another imaging study or biopsy. Unnecessary follow-up studies and biopsies may cause patients anxiety, stress or complications, as well as burden the already strained health care system. Chorney, Michael

Cancer patients may receive follow-up imaging at multiple institutions, especially for emergent complications. Radiologists’ frequent lack of comparison examinations from other institutions hinders the interpretation of these studies. Direct comparison to historical images ought to be readily available to better assess tumors, therapeutic response and emergent oncologic complications.

We encourage practices to transition from CDs to cloud-based file-sharing to have patients’ prior examinations readily available to interpreting providers at all institutions at which a patient may seek care. The comparison image availability would enable faster, better cancer screening interpretation, diagnosis, assessment of disease progression and detection of complications. Costly and sometimes unnecessary biopsies and additional rounds of follow-up examinations would be reduced.

The #DitchTheDisk Task Force actively seeks patient and practitioner advocates as we embark on a journey to change the method of personal health record storage. Please fill out this form or email to get involved.

Stay tuned for our next blog on how CDs impact patient care in the trauma setting. Share your thoughts using #DitchTheDisk on social media, commenting below or by joining the discussion on Engage (login required).