Caring and Communication

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Caring and Communication






Professional Profile



While practicing and teaching radiologic technology for more than four decades, I have observed the results of both ethical and unethical conduct. We are not perfect; mistakes occur. But an informed commitment to ethical principles greatly diminishes the likelihood of errors.


I have served as an expert witness in several cases of medical malpractice that involved unfortunate incidents in medical imaging departments. In one case a patient suffered permanent, incapacitating brain damage because of administration of the wrong intravenous fluid in an emergency situation. This could have been avoided if the technologist had followed orders and obtained the correct solution. A second opportunity to avoid this same error was missed because of incomplete and unvalidated communication between the technologist and the physician.


It is clear that communication is both vitally important and potentially perilous in the practice of health care. Those who are guilty of gossip, thoughtless sharing of confidential information, inaccurate reporting, or incorrect medical recording often cause serious consequences for the patient as well as professional or legal problems for themselves. I participated in another case in which the family of a patient who died of natural causes sued the hospital based on careless, unfounded remarks by a technologist, which were overheard in the imaging department.


We are all tempted to take shortcuts when we are in a hurry, but lack of compliance with safety procedures places both the patient and the imaging professional at risk. I have been called to consult in two cases where patients were injured in imaging departments because of falls. In both situations, injuries occurred when technologists were rushed and failed to make the effort to be careful. Because they were preoccupied with their own concerns, they did not place a high value on the well-being and protection of their patients.


When providing testimony about the actions of an imaging professional, I compare the person’s actions to the code of ethics of the applicable professional organization. I also review the organizational policies and procedures that relate to the situation. Patients rightfully expect their health care providers to be educated in ethical principles and aware of the rules that apply to their care. When principles and rules are not conscientiously applied, unmet expectations raise concerns and resentments, even when no harm is done. These resentments increase the likelihood of a lawsuit. When patients have confidence in those who care for them, lawsuits are rare.




ETHICAL ISSUES


Caring and communication are essential for life and growth; they are crucial ingredients in the imaging professional’s ability to serve the needs of self and others. Caring and communication require the developmental strengths of trust, autonomy, initiative, identity, justice, industry, and intimacy, all of which play a role in discussions of ethics and ethical problem solving for the imaging professional.1


Health care professionals, including imaging professionals, refer to the therapy and other services they provide in their practices as care. Care is shown to the patient through appropriate communication. Therefore caring and communication are the primary tasks of the imaging professional. A caring attitude should influence the imaging professional’s feelings and ethical problem solving arising from interactions and communication with patients. This chapter defines caring and communication, describes their ethical implications for imaging practice, and provides methods to help the imaging professional develop a more caring and communicative demeanor.


Eleanor McMartin explains that the imaging professional plays an important role in maintaining patient autonomy by projecting a caring attitude through appropriate communication.



DEFINITION OF CARING


Caring is defined as a function in which a person expresses concern for the growth and well-being of another in an integrated application of the mind, body, and spirit designed to maximize positive outcomes. Expressions of caring include feelings of compassion and concern, a philosophy of commitment, an ethical approach to problems, altruistic acts, conscious attention to the needs and wishes of others, protection of the well-being of others, nurturing of growth, and empathy and advocacy. Because caring plays such a vital role in human interaction, an appreciation of caring is fundamental to an understanding of human nature.2



Such activities as listening, providing information, helping, communicating, and showing respect are expressions of caring.3 Other caring activities include touching, nurturing, supporting, and protecting (Box 3-1).4 Caring is a universal phenomenon, although expressions, processes, and patterns may vary among cultures.5



Caring is essential in the development of the imaging professional.6 Radiographers must be caring individuals, part scientist and part humanist. Humanism entails the provision of existential care, a more abstract form of care arising from an awareness of common bonds of humanity and common expressions, fates, and feelings.7 Care may occur as a product of the rapport between imaging professionals and patients. Unfortunately, this is not always the case8:



In radiology, particularly, the administrative focus is on reducing costs by increasing productivity. The efficiency of virtually every radiology department in this country is based on how many exams its technologists can complete per hour. This emphasis on speed means that radiologic technologists often must spend less time than they would like getting to know each patient. This can have a detrimental effect on patient satisfaction. Patients who are treated like bodies on a mechanized production line are bound to go somewhere else the next time they need health care. Patients who perceive a lack of genuine concern and empathy are the first to complain about their care and ask for their records to be transferred to another facility.




Communication


Communication is a symbolic interaction: when one person says something to another and that person responds. There has to be at least one response to one initiation, creating a tie of communication. Human communication is how an individual interacts with another. This may be through symbolic interaction or language or both. It is transactional and affective in nature. Human communication is not static, and it involves human feelings and attitudes, as well as the delivery of information. Health communication is narrower in scope than human communication. It is a subset of human communication that is concerned with how individuals in a society seek to maintain health and deal with health-related issues.


The key elements of communication regarding imaging are the speaker or sender (the imaging professional), the language spoken or body language (explaining the procedure and asking for information), the environment (the imaging department), listening (to the patient or to peers, physicians, etc.), and feedback from the receivers.



Care as an Ideal


Philosophically, care is an ideal analogous to beauty, truth, and justice; although it is sought after, it can never be fully attained or perfect in human expression. Imaging professionals are not capable of providing perfect care. In striving for the ideal, however, the imaging professional may occasionally come close to achieving it and in so doing provide great benefits for the patient. One danger in discussing ideals is viewing them as achievable and measurable commodities; this leads to the idea that those who fall short of achieving ideal care should be ashamed.7 This misperception may lead imaging professionals who consider caring to be a vital part of their professional practice to feel guilty, selfish, or discouraged when they are unable to give more time to their patients.9



IMAGING SCENARIO


A patient who has a family history of breast cancer and has found a lump in her breast arrives at a mammography imaging center. She is frightened and emotional. She has read a great deal of literature about breast cancer and knows it is one of the leading causes of death in women. Her mother and sister died painful deaths at early ages, and she is frantic to learn her diagnosis. The breast imaging center has been informed that it needs to complete procedures more rapidly to allow a greater number of mammograms to be performed per day. This pressure for speed has elevated the stress of the mammographers. Moreover, unexpected emergencies and procedures that call for additional views have been causing backups in the waiting room, increasing the anxiety of patients anticipating their examinations. Such a backup occurs on the day the patient arrives, and by the time her procedure begins, she is almost hysterical and has difficulty following the mammographer’s directions. Her inability to hold still and endure the compression necessitates retakes of the films. By the time the woman is finished with the examination, she is angry and vows never to return to the breast imaging center. Her anger may even prevent her from following through with future mammograms.






PROFESSIONAL CARE


Professional care is characterized by the application of the knowledge of a professional discipline, including its science, theory, practice, and art. It is complementary to human caring. Imaging professionals must possess human caring before they are able to provide professional caring. Human and professional caring are both activities of the whole person (although activities are only a portion of caring). The interaction of compassion, knowledge, and the experiences and emotions of the whole person gives rise to human and professional caring.7



Clearly, professional expertise unaccompanied by human compassion is not enough to serve all the needs of the patient: “If we fail to motivate that feeling (empathy and compassion) and the earnest desire within our student to help our fellow man, we will have created the equivalent of human robots.”10 Such an emphasis on skill at the expense of caring and empathy produces a “patient care gap” in which the patient is ignored as the “scale tips toward science and technique.”11



Caring in the Imaging Sciences


The professional and human caring practiced by imaging professionals is based on individual and institutional values. Adherence to a set of values and the use of ethical problem solving help the imaging professional to develop a more caring demeanor. The three strengthen one another. Without values, caring and ethics in the imaging health care environment are without foundation and force. In turn, a strong commitment to caring requires a fusion of feeling, thought, and action, all of which aid the technologist in coping with stress and solving problems ethically. Taken together, caring, values, and ethical problem solving give meaning to professional practice, create the possibility of ever-improving care, and enhance patient comfort and feelings of safety.2 For example, cardiac ultrasonographers who have the ability to make their patients comfortable find them more willing to comply with directions, leading to an examination with greater diagnostic success.


Caring brings together all the resources of the imaging professional. When imaging professionals care for patients by performing imaging procedures, monitoring equipment, and meeting patient needs, they do more than provide therapy; they become a part of the patient’s life.


Caring in the imaging sciences also involves an appreciation of the universal patterns of human experience. As imaging students enter educational programs, they are exposed through their patients to the universality of pain, loneliness, suffering, fear, and looming death. Human caring and professional caring require compassion for the suffering endured by patients and an understanding of the ways in which people construct and draw meaning from their lives. This unending activity of inventing, restructuring, and reinterpreting is universal, even though the outcomes are personal. Compassionate imaging professionals respond to the universal appeal made by suffering human beings by caring. The potential for this response is also universal.7


Imaging professionals see patients in all phases of life and all conditions of health and disease. Because the nature of their practice requires care for a diverse patient population, imaging educational programs incorporate classes to develop skills in caring. Professionals in other modalities, however, may not have as much continued and direct contact with a wide variety of patients and therefore may not be as prepared to care. This disparity may be an obstacle to providing the safe, comfortable environment patients require.


Careful monitoring of radiologic equipment is an activity that shows caring by ensuring the autonomy, comfort, and safety of the patient. Quality control specialists exhibit caring by spending as much time as necessary monitoring imaging machinery. Imaging professionals also show caring for their patients by ensuring confidentiality, obtaining informed consent, thoroughly explaining procedures, and taking complete and accurate histories. Nuclear medicine technologists exhibit human and professional caring by explaining the significance of the radioactive material being injected into a patient receiving a therapeutic dose.


Feb 27, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Caring and Communication
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