I’m pregnant. I just had a pelvic X-ray. Should I be concerned?
The inquiry was sent recently from a reader in Italy to Emily Caffrey, a Certified Health Physicist (CHP) and the chief editor of “Ask the Experts,” an educational website at the Health Physics Society (HPS).
“My gynecologist says maybe,” the reader emphasized.
It was a heavy question, one Caffrey gets all the time. All CHPs do, she says.
“Thank you for reaching out, and congrats on your pregnancy,” the health physics program director and assistant professor at the University of Alabama in Birmingham replied. “That’s exciting news.”
“Everything is fine. You don’t have to worry. The baby is all right.”
Caffrey then explains why.
“Here’s how much radiation dose you receive from a pelvic X-ray. Here’s what research says is an acceptable amount of medical radiation exposure. Here’s what experts know about the effects of radiation on pregnancies.”
All the explanations relax the reader.
“If you want more information, here’s where you can find it,” Caffrey adds, sending over links to more literature.
This is part of the job of a CHP, Caffrey says. It’s natural for patients and their caregivers to express apprehension before, during and after a medical imaging exam or any procedure involving medical radiation exposure.
It’s even expected.
That’s why it’s regularly up to CHPs to direct this intersection of science and emotion without a head-on collision.
What’s more, these concerns will escalate following the latest industry revelation: gonadal shielding, the gold standard for keeping a person fertile by preventing damage to reproductive organs during radiation therapy, provides little to no benefit to patients. In fact, experts warn gonadal shielding could trigger the opposite effect, interfering with automatic exposure control safeguards and inadvertently increasing the dose to other radiosensitive pelvic and abdominal organs.
It’s a game-changer that CHPs will need to communicate delicately to patients and caregivers.
“There will be many questions and concerns shared,” Caffrey said. “We’ll need to be ready.”
She already is.
Peers frequently cite Caffrey as a leading CHP in handling patient and caregiver concerns about medical imaging. For example, Dan Sowers, a CHP and the current radiation safety officer (RSO) at the Defense Threat Reduction Agency in Virginia, calls Caffrey “one of the best.”
You can be too, she says.
All it takes are four tried-and-tested steps.
Put Yourself in Their Shoes
Caffrey says that the first thing CHPs should do when patients and caregivers give them a line of questioning as to why gonadal shielding, the one-time, go-to method for covering the reproductive system during radiation therapy, isn’t needed anymore.
Then, she says, “take stock of the situation.”
“What is that person feeling right now?” she asks. “They’re there for a reason—their loved ones, kids or themselves have a potential problem, or maybe they’re there for a procedure. That’s scary.”
Listen intently to the patient and understand their emotions.
“It’s easy to say, ‘I’m the expert. Listen to me.’ But it’s not very effective,” Caffrey says. “Put yourself in their shoes. Envision what they’re going through. Because the only way you’ll effectively communicate with someone is if you have empathy for their condition.”
Educate, Don’t Persuade
Educating saves time and builds trust.
Studies show that when doctors miss clues about how their patients feel and instead try to influence their decision-making, time is wasted as patients feel compelled to explain themselves again to get the appropriate response.
“It’s a bad goal to try to convince your patients that there’s no risk of harm,” Caffrey says. “They’ll sense that you’re trying to persuade them and immediately react, and not in the way you need to ensure their best health.”
Instead, she says, you want them to know the facts. “Educate them about radiation exposure specific to their situation,” she adds.
So, how do you do best educate?
Carefully recall Caffrey's detailed steps to resolve her Italian reader's concerns following their pelvic X-ray.
“Give them resources, lots of it,” she remarks. “You tell them these are the facts and figures, and here’s the research that supports it.”
Set Measurable Objectives
How do you know if you were successful in making your patient comfortable? It’s an important question to ask, Caffrey says.
“You need to set measurable objectives to learn whether you’re communicating in a way that resonates well with your patients,” Caffrey says. “It’s the only way to know whether your educational efforts were successful.”
You’ll also never know whether you have enhanced faith in your organization.
“If you’re an RSO at a hospital, your ultimate goal isn’t to persuade; rather, it’s to build and increase trust,” she says. “You commonly measure this through tactics like anonymous patient surveys.”
What questions should patient surveys ask?
“How do you feel after you talked with one of our staff members? Did they help you?” Caffrey suggests. “If so, how? If not, why not? What can we do better?”
CHPs are always looking for ways to perform better, she adds.
Know Your Audience, Pick the Right Platform
One more thing, Caffrey adds. It’s a big one, too: Be aware of who your audience is and how they want to be communicated with, because both will always differ from one patient to the next.
For patient-specific issues, like whether gonadal shielding is needed for a specific exam or procedure, one-on-one conversations (in person, over the phone, via email) are best.
“Patients want to make sure you’re not giving them a generalized answer. They want a response specific to their exact situation,” Caffrey says.
But you can get ahead and answer some of those concerns before they take a step in your clinic.
“Consider your website content,” she says. “Think about your social media content or what you’re saying at public meetings, conferences and events. For example, how well are you explaining this dramatic industry change to those who have heard that gonadal shielding has been a must for 70 years?
“How are you reaching the individual or individuals of concern?” she adds.
That’s the beauty of being an editor at HPS’s “Ask the Experts” website. It has taught her many of the communicative skills outlined here: empathy, listening, educating, never persuading.
“This is one of my outlets for helping get the right message out across the right platform,” she says.
Why Managing Patient Communication Matters
Research has shown a direct link between how well CHPs communicate with their patients and their health outcomes.
Improved communication between CHPs and patients also enhances job satisfaction and reputation while reducing medical errors and patient safety events.
The best part is better communication does not necessitate more time or additional costs from CHPs.
It requires critical self-analysis and implementing four key steps, all of which underscore what Caffrey says is the most important thing for patients to know: We see you. We hear you. We understand you and accept you, and we’re here for you.