Connections that are remote but real.

Reading screening mammograms, all alone in the breast imaging center on a Sunday, might on the surface seem as disconnected as it's possible to be from the patients whose studies I'm interpreting. And yet this apparently "Imaging 2.0" experience is still a chance to deliver value around the interpretation.

 

Screening means looking for disease before it has made itself clinically apparent. My colleagues who are reading CT and X-Ray today are encountering a wide range of patient complaints and disease entities. While I have only one enemy to track down, it can be a Protean opponent. This one disease entity, breast cancer, might reveal itself in 3 different women in 3 different ways today or I may not encounter it at all. It might present in the first set of images or the last. I know that over time I will see it in about 3-4 of every thousand mammograms I read but I'll never know in advance where it lurks.

 

For me, the automation of the image viewing and reporting process is what allows me to focus on the images. We have so many boxes to check, log ins to remember and buttons to push, all with very laudable goals, the interpretation of the images can easily feel like an afterthought. So it's vital to corral all the IT and QI demands and organise my work environment so that my eyes and my attention are laser-focused on the task that is my unique duty as a radiologist.

 

At the same time, I want to make the most of the information that is available to me. Yes, these are screening mammograms, and I’m really tasked with decoding the images. But a picture of the patient pops up in Epic and the stories in the patient history sheet are a constant reminder that these women are my patients and they're depending on me to get it right for them. "Do you have any family members with breast cancer?" Mother, aged 32. "Number of pregnancies" 3 "Number of live births" 1 "Are you being treated for any other cancer?" Lung. Each of these data sets is not only a patient, but also potentially a friend, a relative, a colleague, or a community member, even if they're a stranger to me.

 

I have often been asked why we don't read screening mammograms while the patient is still in the office. I know there are practices who do, and I know that to our patients it can seem like those of us who batch read are putting our convenience ahead of their very understandable desire to know their results as soon as possible. The truth is much more nuanced. Batch reading allows me to focus and reduces the number of times I ask for extra images. It also means I can be available to more patients overall to read their mammograms.

 

What I do "get" is that, with changing benefit design, patients are now paying much more out of pocket for their care. Even though their screening mammogram is "free" with no copays or deductibles, any "call back" diagnostic mammogram can end up costing them and add to a sense that we are not putting their needs first. That's why I am actively working on payment models that would align the principles of high quality breast screening with our patients' priorities. The remote but real connections that I make with the patients whose screening mammograms I interpret are a powerful incentive to deliver the most effective care possible.