BIBB ALLEN JR, MD
ACR CHAIR’S MEMO
What if All Our Patients Were Friends or Family? There are two principles I try to adhere to in my practice, and I suspect these are true for most of us. First, our friends and family are better off when we treat them just like our typical patients. We should not alter our decision-making processes, nor should we cut corners to make their encounters with the health system easier. Second, when making difficult decisions for a patient, I often make my final decisions on the basis of what I would do if the patient were my wife, a parent, or one of my children. That said, there is a natural tendency for us to provide a bit more personal attention for our friends and family when they come for imaging studies. First of all, we want to be certain we do the most appropriate examinations to answer the clinical questions. That all too often requires conversations with their physicians. We also make sure we choose the best protocol to avoid excessive radiation, and we frequently share the results of their examinations before they leave. If they have imaging findings that require follow-up, we make sure they understand exactly what they need to do. Although I am not suggesting we can do this for every patient every time, it illustrates that a significant amount of important imaging care is
occurring before and after the interpretation, and that care is often not being directed by radiologists. If as radiologists we were able to take ownership of that care and treat all our patients as if they were our friends and family, I believe we would improve individual patient safety and outcomes, demonstrate radiologists’ ability to provide more cost-effective care, improve our patients’ engagement with their imaging care, and significantly increase radiologists’ relevance to the health care system. This is the model for value-based imaging care in clinical practice. But there’s a problem. Most times I dread the days my friends and family come for imaging, and the reason I dread it is because it disrupts my daily workflow. Somehow while I am doing those extra things that we do when we care for our friends and family, the other work goes on, and I end up way behind for the rest of the day. So the challenge for the specialty is to develop tools that can identify those patients for whom radiologist intervention can make a difference and integrate those tools into our daily workflow. These tools should provide for standardized evidence-based care whenever possible and be available at our major touch points: the PACS, the dictation system, and the electronic health record. These tools include clinical decision support for
ordering physicians and decision support for radiologist recommendations that is based on guidelines from expert consensus panels. By adopting radiation protection tools available on modern CT scanners and by tracking radiation exposure through registry reporting, radiologists can show their commitment to the principles of Image Gently and Image Wisely. Patients can be empowered to become more involved in their imaging care through personal imaging records, Image Gently and Image Wisely, and RadiologyInfo.org. Radiologists will need to recognize that there will be a need for a shift in our own culture to achieve these goals, and payers, policymakers, and health systems will need to provide appropriate incentives to support the value radiologists add beyond the interpretation. Organized radiology can play a pivotal role in supporting the specialty through this transition, so check out Imaging 3.0 at acr.org and Radiology Cares at rsna.org for the details. As your new ACR Board chair, it is my pledge that the ACR will work to provide the specialty with the point-of-care tools that will empower radiologists to realize the goal of treating all our patients like our friends and family and enhance our value to our patients, referring physicians, and the health care system.
Bibb Allen Jr, MD, Trinity Medical Center, 800 Montclair Road, Birmingham, AL 35213; e-mail: [email protected].
ª 2014 Published by Elsevier Inc. on behalf of American College of Radiology 1546-1440/14/$36.00 http://dx.doi.org/10.1016/j.jacr.2014.03.023
435
ACR CHAIR’S MEMO
What if All Our Patients Were Friends or Family? There are two principles I try to adhere to in my practice, and I suspect these are true for most of us. First, our friends and family are better off when we treat them just like our typical patients. We should not alter our decision-making processes, nor should we cut corners to make their encounters with the health system easier. Second, when making difficult decisions for a patient, I often make my final decisions on the basis of what I would do if the patient were my wife, a parent, or one of my children. That said, there is a natural tendency for us to provide a bit more personal attention for our friends and family when they come for imaging studies. First of all, we want to be certain we do the most appropriate examinations to answer the clinical questions. That all too often requires conversations with their physicians. We also make sure we choose the best protocol to avoid excessive radiation, and we frequently share the results of their examinations before they leave. If they have imaging findings that require follow-up, we make sure they understand exactly what they need to do. Although I am not suggesting we can do this for every patient every time, it illustrates that a significant amount of important imaging care is
occurring before and after the interpretation, and that care is often not being directed by radiologists. If as radiologists we were able to take ownership of that care and treat all our patients as if they were our friends and family, I believe we would improve individual patient safety and outcomes, demonstrate radiologists’ ability to provide more cost-effective care, improve our patients’ engagement with their imaging care, and significantly increase radiologists’ relevance to the health care system. This is the model for value-based imaging care in clinical practice. But there’s a problem. Most times I dread the days my friends and family come for imaging, and the reason I dread it is because it disrupts my daily workflow. Somehow while I am doing those extra things that we do when we care for our friends and family, the other work goes on, and I end up way behind for the rest of the day. So the challenge for the specialty is to develop tools that can identify those patients for whom radiologist intervention can make a difference and integrate those tools into our daily workflow. These tools should provide for standardized evidence-based care whenever possible and be available at our major touch points: the PACS, the dictation system, and the electronic health record. These tools include clinical decision support for
ordering physicians and decision support for radiologist recommendations that is based on guidelines from expert consensus panels. By adopting radiation protection tools available on modern CT scanners and by tracking radiation exposure through registry reporting, radiologists can show their commitment to the principles of Image Gently and Image Wisely. Patients can be empowered to become more involved in their imaging care through personal imaging records, Image Gently and Image Wisely, and RadiologyInfo.org. Radiologists will need to recognize that there will be a need for a shift in our own culture to achieve these goals, and payers, policymakers, and health systems will need to provide appropriate incentives to support the value radiologists add beyond the interpretation. Organized radiology can play a pivotal role in supporting the specialty through this transition, so check out Imaging 3.0 at acr.org and Radiology Cares at rsna.org for the details. As your new ACR Board chair, it is my pledge that the ACR will work to provide the specialty with the point-of-care tools that will empower radiologists to realize the goal of treating all our patients like our friends and family and enhance our value to our patients, referring physicians, and the health care system.
Bibb Allen Jr, MD, Trinity Medical Center, 800 Montclair Road, Birmingham, AL 35213; e-mail: [email protected].
ª 2014 Published by Elsevier Inc. on behalf of American College of Radiology 1546-1440/14/$36.00 http://dx.doi.org/10.1016/j.jacr.2014.03.023
435
