Radiology is a service industry
lthough I am democratic person, I like the simple hierarchies of the service industry, as practiced, for instance, in a good restaurant.
A hierarchy is a structure of group members arranged in order of importance or according to the degree of their skills and responsibility. The crucial event for their development in what is called today the “hospitality industry” can be tracked back to the introduction and evolution of sophisticated cooking brought into France from Italy during the Renaissance period.
In the kitchen the brigade de cuisine – the kitchen team – consisting of highly trained experts, each with clearly defined duties, takes care of preparing the meals.
In the dining room proper, the maître d’hôtel supervises customer service, the sommelier proposes and serves the wine, your personal waiter looks after your table. You – the client – become the focus of their attention, usually combined with a friendly smile. They all are trained to spoil you. Similar hierarchies exist in good hotels and small airlines.
In hospitals, hierarchies are slightly different. Commonly, a head administrator is on the top, followed by the chief doctor, the head nurse, the porter, the rest of the doctors, the nursing and paraclinical staff, and the janitors. Yet, while this team originally focused their attention on patients, in many instances hospitals and the health system at large would rather do without patients. This, at least, is my personal experience with sick members of the family and friends in different European countries. Many people with whom I have talked over the past few years share this view. Patients are often considered a nuisance. Hospital staff would prefer to get on with their administration unhindered, without minding their original task.
"Let us be courteous and attentive to patients, keep them informed, and lend them some dignity."
Working as a medical doctor or a nurse means working in a serving profession. Radiology, as a medical discipline, means service. Oh, I can see eyebrows raising. “How can you compare medical doctors with waiters?” Granted, there are fundamental differences such as length of training, difficulty of the tasks involved, and nature of responsibilities.
However, just like staff in restaurants, medical personnel have to focus on their clients, the patients whose interests are foremost.
Staff shortages are often used to counter any suggestion that there might be a problem. This is true. In some European countries it is the rule and a necessity for the survival of the patient that members of the family or hired private nurses tend to in-patients – not only in Ruritania, also in Autobahnia. A discussion of the reason lies beyond our radiological topic.
Radiology is a short-term service enterprise. Usually the customer arrives, undergoes an examination, and leaves within the hour.
Admittedly, the last sentence can be discussed and rephrased as follows, because of the scenario is different:
The patients looks for the x-ray department and after some searching and asking finds it in the basement at the other end of the hospital complex. He are she is welcomed by a grunting receptionist and told to sit down wherever there is a chair. The walls of the waiting room are painted in pissoir green and chairs and tables are marred and scored.
The patient waits without any further explanation for an hour. Then he is told that he should have taken a numbered ticket from a ticket distributor on the wall of the corridor.
Suddenly a nurse arrives and ushers the patient to a changing cubicle that is occupied by an elderly half-naked woman. “You shouldn’t be in here,” the nurse snarls at the lady – who responds: “I do not know what to do. I guess they have forgotten that I am here.”
Our patient is led to the neighboring cubicle but does not know whether to undress and which clothes to remove, waits with bare feet on the cold floor for twenty minutes, then is examined without any explanation. Returning to the changing cubicle, the patient does not know whether to dress or to wait. He finally dresses and leaves the cabin to ask the receptionist what happens next, and is sent home without getting any information about the outcome of the study. The whole procedure takes three and a half hours. In the meantime the car he has parked in front of the hospital has been towed away, the babysitter has gone home, and the unattended children emptied the beer bottles in the fridge.
Many patients are fearful and confused by procedures at hospitals and medical clinics. Anxiety is generated because a physician has ordered some “tests” – whatever that may be.
Never forget that most patients have only heard of x-rays, ultrasound and maybe the existence of ‘scanners’.They cannot distinguish CT from MRI or PET. In the “information society”, information on any topic might be available, but that does not mean that people really know about it – nor do they understand. Even our medical colleagues have only a basic understanding of modern medical imaging.
Most patients are intimidated when arriving at a hospital or private office. At hospitals it may be difficult to find their way. What used to be the Roentgen or x-ray department has turned into the diagnostic imaging department, divided into subsections dubbed with strange acronyms. Often the reception areas look like administrative offices of the tax department or the police. We are in charge. Who are you and what do want?
If you put yourself or a member of your family in the position of the patient: Don’t you expect another kind of welcome?
Therefore, to reduce apprehension, hire a friendly and warm person as receptionist to greet patients. Staff should be properly dressed and wear tags with their name and job title so that patients know with whom they are dealing.
Take time for patients, explain the procedures – not only the medical procedures, but everything from the location of the waiting room to when the results will reach the referring physician or the patient. Worrying about an examination’s outcome is common and easily understandable, yet there are reasons why radiologists will not disclose results to the patient and sometimes won’t talk to the patient at all. However, patients need to know when the result will be available, and to whom it will be communicated.
The same simple courtesy you except in a restaurant should be available to patients in hospitals. When making an appointment, for instance, try to oblige the patient’s preferences. If there are waiting times and delays, inform the patient.
The waiting area should be spacious, friendly, and clean. It should separate inpatients and outpatients. Reading material should be new and not dirty from many sweaty fingers. If babies and children are examined in the department, their waiting area should be separate and contain – clean – toys they can play with.
Very often personal dignity is hurt in hospitals. Patients feel humiliated when they are naked or partly naked and do not know what is expected from them. Just a smile and a short explanation will help. Hospital gowns should not be flimsy, and gowns and blankets should be clean.
Many medical personnel, radiology professionals included, believe that state-of-the-art equipment is the most important facet of their job. Of course, it is great to possess the latest machines and gadgets, even if they are not built to accommodate patients comfortably and the patient bed is narrow and cold.
Sometimes it is very difficult to climb on the patient couch, and even more difficult to get down after the examination. Many patients need help, even if they don’t look fragile and incapacitated.
Sometimes patients vote with their feet against certain radiological equipment, as it happened with high-field small-bore MR equipment in the United States. Patients preferred open machines because they are more comfortable and induce less claustrophobia. However, this is the exception rather than the rule.
Many people prefer a hamburger joints to restaurants. Eating fast food is more time-efficient and can be cheap. Although efficiency and time saving are also keywords in medicine, they are often misinterpreted as fast and impersonal handling, mass production, and loss of individuality. Yet, individuality, “personalized medicine”, is a principle element of the medical profession. It must not be lost.
A cynical argument in favor of the hamburger-joint approach to medicine is that clients will keep coming anyway, so why bother to change? Something is fundamentally wrong with the health system if you can apply this argument to radiology. In this case, health administrators need a course in ethics and radiologists need more competition.
Little advice exists about how to improve patient handling, despite plenty of studies about how to improve cost-efficiency, and sensitivity and specificity of diagnoses. Patients seem to have been kept out of the picture.
Recently I came across a publication by the Board of the Faculty of Clinical Radiologists of the British Royal College of Radiology. The title says it all: “Making your radiology services more patient-friendly” . It is a small booklet to help departments of clinical radiology to succeed to put patients at their ease. This booklet can only be highly recommended for everybody in radiology. It is to the point, contains many useful hints, and has a very attractive layout.
The contents cover four main topics: the department, communication, before and during the diagnostic procedure, and after the procedure. Many of the suggestions sound easy and unsophisticated; however, why aren’t they implemented in all hospitals?
1. Board of the Faculty of Clinical Radiologists of the British Royal College of Radiology. Making your radiology services more patient-friendly. The Royal College of Radiologists; 38 Portland Place; London W1N 4JQ; United Kingdom. www.rcr.ac.uk