As jobs or roles change, moving up and down the various levels of the hierarchy and being at different levels in different roles would be normal. For example, a new husband may be at the fourth level at work but at the third level in marriage.
To interact effectively with patients, understanding that patients may be in an altered state of consciousness is important. They are in an unfamiliar environment in which they are no longer in complete control. In addition, they often fear not knowing the exact state of their health. Preferring bad news to uncertainty—because, at least, plans can be made to cope with bad news—is not unusual for a patient, whereas uncertainty leaves a person without the means to attempt to control the situation. Empathizing with these feelings is difficult until they have been experienced personally.
Most patients would prefer not to be in the care of health care professionals, including radiologic technologists. Even the kindest and most cooperative patients are simply making the best of a situation they would prefer to avoid. An injury or the potential for disease or illness exists; otherwise they would not be seeking medical care. In many instances, patients’ fear of what the images may confirm or uncover causes them to be inconsiderate, arrogant, impatient, rude, or overly talkative or to exhibit other characteristics as they attempt to cope with their situation.
The patient may arrive for care at the first level of Maslow’s hierarchy of needs, which is the physiologic or survival level. Illness or trauma may have altered many physiologic functions, which in turn may cause the patient to behave out of character.
A lack of satisfaction in level one needs can cause a patient to be unable to satisfy the other, higher needs. For example, if a female patient is very sick, she might lose sleep (level one) over how she will keep her job and maintain her home or belongings (level two). When a patient arrives with a nasogastric tube (Fig. 11-2), although normally very friendly and talkative, he or she may not want to be around other patients while the nasogastric tube is in place (level three).
As with most medical professionals, radiologic technologists have an awesome responsibility when interacting with patients because of the tremendous power that is held by health professionals over patients. This power is so great that it includes the most basic elements of a person’s dignity and self-respect. Inconsiderate abuse of this power may seem to be difficult to avoid because of the nature of the examination procedures. Consequently, special attention is needed to ensure that the power is not abused. For example, when patients are required to wear flimsy patient gowns, when they are referred to as the upper GI series or the barium enema instead of by name, or when they are placed in proximity to other patients who are more critically ill, patients can feel dehumanized. Maintaining self-respect is difficult while trying to get to a toilet before evacuating barium from the bowel, when vomiting, and in other uncomfortable situations.
Professional radiologic technologists should learn about different types of patients, along with various methods of communication that are effective with each. Two main classifications of patients can be considered—inpatients and outpatients. Each type has typical characteristics that require different approaches and interaction skills on the part of the technologist. Whether the patient is an inpatient or an outpatient, one of the initial patient communication skills is patient assessment. Initial patient assessment by the technologist usually comes in the form of chart or procedure request review or both. Much information can be learned from reviewing these two sources concerning patient history and indications for or contraindications to the requested procedure. Second, patient assessment by the technologist usually comes in the form of verbal communication. All health care professionals should introduce themselves to their patients, explain the procedure to patients, and obtain a brief history. Many medical imaging departments have patient questionnaires requiring that the technologist ask patients pertinent questions regarding their history and medical status before a procedure can be performed. In other instances, if a patient is scheduled to have an invasive procedure or if the use of intravascular contrast media is required, obtaining informed consent is often the responsibility of the technologist. In either instance, good communication skills are a must.
An inpatient is someone who has been admitted to the hospital for diagnostic studies or treatment. In general, these persons occupy a hospital bed for longer than 24 hours. Inpatients often move up and down Maslow’s hierarchy before arriving in the care of the radiologic technologist. Gaining the patient’s confidence is important, even though he or she may be in a somewhat agitated or bewildered state of mind. Previous experiences in the hospital may have shaped the manner in which the patient responds to these initial interactions with the technologist. For example, a patient with severe lower back pain who has been transferred from a bed to a cart by inexperienced nursing staff may be skeptical of a radiologic technologist’s assurances of a smooth and careful transfer onto a medical imaging procedure table.
The inpatient may be transported to the radiology department by wheelchair or cart or may walk (ambulate). While in the waiting area of the department, the patient has an opportunity to hear and see many departmental activities. Technologists should always be aware that, although they are familiar with the department and may take waiting patients for granted, patients are listening and watching everything in anticipation of how they may be treated.
An outpatient is someone who has come to the hospital or outpatient center for diagnostic testing or treatment but does not usually occupy a bed overnight. Outpatients arrive in the radiology department with prior expectations. They often expect to be seen immediately on arriving in the department because they have a scheduled appointment. Maintaining a schedule in any medical setting is difficult because of unforeseen circumstances. For example, follow-up images on a previous patient may take longer than expected; a radiologist may require extra projections to be certain of a diagnosis; or patients may become ill, refuse examinations, or be unable to cooperate fully. Apologizing for delays and trying to keep waiting patients up to date on their status is certainly appropriate and important—for example, telling a patient that it will be 20 minutes before he or she can be seen is appropriate if no emergencies exist. If something unforeseen occurs, then little extra time is required to say, “I’ll be with you as soon as I finish with one more patient,” as you walk by 15 minutes later. Patients greatly appreciate the simple fact that you are aware they are waiting and you perceive their patience. More positive comments are received by hospitals from these types of interactions than for any other reason.
Because outpatients often have insurance or government benefits of some type, they may expect priority treatment. A professional should provide the same care and attention to all patients regardless of status. This care can be especially difficult when a patient is a famous personality, a correctional inmate, or public official or otherwise known.
Interacting with the Patient‘s Family and Friends
The patient’s family and friends who are visiting also must receive attention. Because they spend much time waiting, they tend to critique everything about the technologist, from appearance to tone of voice to smile (or lack thereof). Being courteous to visitors and relatives, as well as to the patient, is important. Relatives are justifiably concerned and may ask questions such as whether the technologist sees anything abnormal or whether a fracture is present. Thinking about how the family and friends feel or considering how concerned you would be about a member of your own family would help. But the technologist must also be aware and remember that he or she is prohibited from rendering a diagnosis at any time and of any sort.
The same needs function for family and friends as for the patient and technologist. Abnormal or rude behavior may be the result of anxiety, concern, or stress. Being asked for an interpretation of images is common for the technologist. An important point to remember is that family and friends often listen closely to everything a professional says (Fig. 11-3). Any statements in response to this type of question may be construed as diagnosing, which is practicing medicine without a license and is illegal. The best response is usually to indicate that the findings are available to the referring physician and that only he or she can provide the information.
The radiologic technologist has a responsibility to make patients, as well as their family and friends, feel confident that they are receiving the best possible care and that they are considered important and special. A smile and brief explanation of the procedure, with extra attention when delays occur, goes a long way in making everyone feel more relaxed and confident.
Methods of Effective Communication
Attention to the various forms of interaction and communication techniques that have proved effective in improving relationships with patients can produce dramatic results in clinical situations. Accurate and timely communication is essential to providing high-quality patient care. A coordinated, team approach is required, with the patient at the center. Developing patient–provider rapport paves the way for an interchange of information that makes the patient feel at ease, leading to better cooperation. Communication comes in many forms, and health care practitioners must be aware of them all; otherwise, although they may not verbally communicate an idea or thought, other forms of communication may be conveying the message, positive or negative.
The methods of verbal communication that are used in establishing an open relationship between the health professional and the patient are basic to the quality of the interaction. Vocabulary, clarity of voice, and even the organization of sentences must be at a level appropriate for the patient. For example, a discussion of units of radiation dose is probably not of interest to a Protestant minister. Conversely, telling a physics teacher that a chest x-ray examination is similar in dose to a few minutes of sun tanning is equally inappropriate.
An important point to remember is that, whenever possible, verbal communication should occur face to face. This approach typically makes others believe that they have your undivided attention, that your concern is only for them, and that they are the only person about whom you care at this specific point in time. Be polite and focus attention on the listener’s perception of the manner in which you are communicating. Remember that cultural, generational, and individual differences may affect a person’s perception of what you are trying to convey. Be careful not to patronize or otherwise demean an individual.
The value of humor in medical settings is well documented. Using humor to relax and open up conversation is acceptable, but the technologist must be extremely careful to avoid cultural slurs and references to age, sex, diseases, and the abilities of other health professionals. The fact that many patients use self-deprecating humor about their disabilities or fears as an emotional release must not be construed as permission for the radiographer to joke in a similar manner. Laughter is good medicine, but when humor is used in an incorrect manner or wrong context or is perceived as unprofessional, it becomes a tool that may prohibit good communication. For example, if a patient asks about the specifics of a medical imaging procedure and the reply is, “I don’t know; this is my first time performing this procedure,” this response may be humorous to the technologist, but the patient may become apprehensive about having an inexperienced person performing the examination. This apprehension may lead to closure of all communication channels between the two parties.
Paralanguage is the music of language; it is often considered a form of nonverbal communication. Patients receive signals about your attitude toward them from the pitch, stress, tone, pauses, speech rate, volume, accent, and quality of your voice. For example, because the mind works faster than the voice, thinking of a response when someone who is talking pauses is common. This knowledge can be used to structure productive questions. For example, asking a patient “Exactly where does it hurt most?” may not produce as much information as saying “You said it hurts a lot around your stomach. Now exactly where would you say the pain is usually greatest?” The second statement gives patient time to recall what he or she said and to think specifically about the statement before being asked to answer.
Patients quickly perceive nonverbal communication such as the tone of voice, speed of speech, and position of the speaker’s extremities and torso (body language). Radiographers must be cautious to avoid giving confusing signals to patients by saying one thing and acting in a totally different manner. For example, asking a patient if he or she is comfortable but neglecting to offer a positioning sponge to hold an oblique position may call into question the sincerity, and consequently the trustworthiness, of the technologist. Positive nonverbal cues increase the quantity and quality of communication and improve the history. For example, the technologist should look at patients and show interest in their statements. Eye contact in many cultures, but not all, is seen as reassurance that the person is concentrating only on the individual with whom he or she is speaking. Smiling, responding candidly, and using a friendly tone of voice all work toward this end. Negative nonverbal cues also can be used to improve the history. For example, looking puzzled may prompt the patient to elaborate on exactly how an injury occurred and may provide the radiologist with details on the direction of the force that caused a fracture. While speaking with patients, the radiologic technologist, as well as the radiologist, should avoid standing away from them with the arms folded across the chest. This body language is generally perceived as someone who is on the defensive, has something to hide, or is repulsed by the patient. Rolling of the eyes, shrugging of the shoulders, and looks of disgust should never be exhibited.
The radiologic technologist commonly uses three types of touch: (1) touching for emotional support, (2) touching for emphasis, and (3) touching for palpation. Few things are more reassuring than a gentle pat on the hand or shoulder as a form of emotional support (Fig. 11-4). Many people respond extremely well to touch, and using this technique is acceptable, as long as proper social conventions are followed. The use of touch conveys to patients that the technologist is trying to understand, be empathetic, and care about them as people. Gentle support under the arm to assist patients to and from the imaging room and onto and off of the table often provides reassurance to the patient that he or she is being cared for by a professional practitioner.
Touching for emphasis involves using touch to highlight or to specify instructions or locations. For example, after a posteroanterior chest radiograph has been performed, patients can be instructed to turn their left side toward a chest unit by a gentle touch at the posterior left shoulder accompanied by a similar touch at the anterior right shoulder (Fig. 11-5). Likewise, after a patient states, “My stomach hurts here,” and places a hand on the upper abdomen, the technologist can elicit further information by asking, “Does it hurt more here or here?” while touching the duodenal and gastric regions.
Palpation is the application of light pressure with the fingers to the body. Palpating to locate various bony radiographic landmarks when positioning patients, is advisable and helpful. In a similar fashion, using specific palpation is often useful to determine a more exact localization during history taking. Effective and precise palpation requires the gentle use of fingertips (Fig. 11-6). The use of the palm or several fingers is less precise than using fingertips and may in some instances be painful or even offensive to patients. For example, a 14-year-old girl is usually more comfortable if a male radiographer palpates for the iliac crest with the tip of a finger than if the entire hand is used to feel the hip region. Before touching a patient, his or her permission to do so should be obtained. Touching without consent can have legal ramifications.
Most programs in radiologic technology have a dress code for students. Although dressing according to a code does not produce better technologists, a professional appearance in the medical setting says as much about technologists as their technical abilities say about their competence. Professional dress helps the patient feel comfortable and confident in the technologist’s abilities. Gaining the patient’s confidence and trust is a considerable part of being a competent radiologic technologist.
Personal hygiene is as important as professional appearance. Personal grooming sends a powerful message. Unkempt individuals may prompt patients to suspect that the person’s professional behavior is similar to his or her appearance—neglected and disheveled. Hair, nails, and teeth should be neat and clean. Nails should be kept at a manageable length, without the use of acrylics, which have been banned in many health care institutions. Body odor emanating from anyone causes others to react negatively, suggesting that the person is unclean. Daily baths or showers, good oral hygiene, and the use of personal hygiene products may be eliminate this problem. The use of strong perfumes, colognes, and aftershaves should also be avoided. Patients may react to certain smells becoming nauseated by any smell that may affect them negatively. A patient will not communicate with someone with whom they do not desire to be in close contact.