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OK, I think we should start now. Ok. Welcome to our talk on a patient centered approach to communicating imaging. The team, we are fifth year medical students at Edinburgh University. We are interested in improving medical communication from doctors and medical students to patients with a focus on medical imaging as this is frequently carried out heavily relied upon and often overlooked in terms of importance of how we convey findings. We aim to address this by creating an accessible approach that students and doctors can use and adapt themselves to facilitate better discussions between them and their patients. Think back to a time you have noticed a doctor discussing a scan well with a patient. What did it look like? How was the patient's reaction? Perhaps there was a clear aha moment when the penny dropped. What about a time where you saw a similar consultation being carried out poorly? How did this leave the patient feeling, perhaps confused or anxious? We are now going to share our experiences of good and bad communication of medical imaging. So firstly, I attended several orthopedic clinics with the same consultant and he had very good communication. He would take the extra time to orientate the patient on the anatomy. And he did this by finding simple anatomy images from Google. And sometimes he would even get a piece of paper and take it back to basics and draw it out. And he would double check the patient's understanding. And you could really tell that they appreciated him taking the extra time to do this. Um It allowed them to feel more involved in their care. And I noticed it had also allowed patients to ask more specific questions about their management options um and to make a better informed decision regarding what route they wanted to take. So for example, whether they wanted to go down a more conservative approach or whether they wanted to go for operation A over operation B, um I saw a useful consultation between an orthopedic consultant and a patient who had an intramuscular hemangioma on the buttock. The patient was quite keen for surgery and requested it almost immediately after the consultation had started. Um the consultant, however, um showed the patient his um CT scan and explained using the scan that surgical intervention would mean cutting away a significant portion of uh his gluteus maximus muscle. So the surgery would in fact cause more issues um than he was currently facing. In this case, the the scan was used to educate the patient on why surgical management may not be as beneficial as the patient believed. By the end of the consultation, the patient appeared to understand the risks and was willing to try alternative management strategies here. The patient was satisfied with the outcome despite it not being what he'd hoped for. I thought that this was a good example of scans being used to justify why certain treatment options are not beneficial. I'll pass it over to Sby now. Thank you. Um So my two cents isn't really about a specific patient encounter. Um, but rather, um just more generally about a time before medical school, a long time ago when I was working as a physiotherapist. Um So in the outpatient setting, we actually did spend a long time speaking to patients, both about the scan results that they might have brought to us from having done previously, um or talking to them about why a scan may not necessarily be indicated in their case. And as Karishma said, explaining why it's not necessary to have a scan is just as important as explaining why it may be indicated. And being in that role, really taught me that not rushing this aspect of the consultation can save you a lot of time in the future when it comes to managing patient expectations, educating them about their bodies, um improving overall outcomes and even preventing potentially unnecessary exposure to radiation as demonstrated the ability to clearly convey imaging findings to patients is an important skill to have. We hope that through the Sales Protocol, you have a framework to guide you in achieving this. But what are some of the challenges to good communication? Firstly, scan can be confusing medical terminology and anatomy is unfamiliar to most patients. Even the statement your scan is clear can leave patients confused what's causing my symptoms. Then is there anything you can therefore do to help with my pain? Worry being in hospital is often a stressful time for patients addressing this aspect. In addition to the medical issue is therefore important beliefs, preexisting beliefs. For example, they may think that having cancer means it is terminal, even though some cancers are curable or that after an injury, they should completely bed rest when physiotherapy and exercise may be recommended instead and time. How do we address all of these factors when there is limited time per appointment slot due to high waiting list benefits to good communication. Firstly, curiosity patients are often curious as to what's causing their symptoms. We can use this to our advantage by helping them better understand their condition and working with them to create an effective management plan as they are part of the multidisciplinary team. Secondly, empowering good communication and a patient centered approach leads to to them feeling more in control and finally satisfaction. It helps to alleviate their worries as they feel seen and heard as well as up to date on recent findings and their treatment options. Great. So before we could um design a protocol for speaking about scans, we had to do a little bit of a dig into the literature that exists to see what mattered to patients first. Um Sorry, the slide is a little bit cut off. We tried to fix that, but hopefully, you can still see the main points. So firstly, it's worth mentioning that research into this is actually pretty limited. Um As well as this, of course, every patient's expectations and priorities will be slightly different. But we did find some overarching themes which later informed the seals approach, which we will go over shortly. Thirdly, and perhaps um this is a topic for another talk. Uh But we found out a lot of patients didn't actually know who radiologists were, um didn't know that they were medical doctors and that they were the people responsible for um actually interpreting the patient's imaging. So here's just briefly what we found from doing some preliminary reading. Um Firstly, the thing that mattered to patients most was the speed of getting their results. Um So, um as opposed to the mode in which they got it, so be it by email, telephone call, a face to face consultation or a letter, 40% of patients found it unacceptable to wait for over one day for the results. But as of course, many of you will know most centers will be under huge amounts of pressure. Um And radiologists may not be able to deliver those results in a day um as well as interpreting the imaging and getting those results out to a patient, there may be certain delays that are not in our control. And of course, some scans may take longer than others to be interpreted. For example, an MRI of a complex um cancer staging um will take significantly longer than a straightforward x-ray of um a fractured arm in an A&E setting. So basically, when results are normal, patients just wanna hear in the fastest way possible. But when the results are abnormal, in terms of, they indicate a significant injury, a significant disease process or even a significant incidental finding patients would prefer to hear from the clinician who referred them for the scan as well as the reporting radiologist as opposed to someone like their general practitioner who wasn't as heavily involved in that aspect of their care. Um Of course, this isn't always possible, but it does show that patients are curious about their care and they want to be involved and hear from experts. And secondly, overall, um the key findings were that basically seeing a scan provides patients with a better understanding of what's going on with them. It provides validation for some of the symptoms or all of the symptoms that are attributed to that disease process or that episode of care. It also empowers them to take greater control over their health and reduced worry in about 93% of patients as well as this. Um it increased trust between the doctor and the patient and that is incredibly important for the therapeutic relationship and can have a really positive outcome on that patient's stay in hospital or just overall on their health. And we hope that some of this research will highlight the reasons why we think it's really important that you take the time to show patients their scans, the literature evidence and our clinical experience that we shared illustrates the need for educating patients about their scans. But what actionable steps could we take to improve communication with our patients about their scans in a way that is meaningful and empowering to them. This is why we've devised seals, a framework that we came up with to guide you when you talk to patients about their scans, it's flexible enough so you can adapt it to your own style and you can use it in all healthcare settings for all different types of scans. So CT S, MRI S ultrasounds or x-rays, it highlights what we found during our research and provides opportunities for patients to see more scans. A key finding during our literature review was that doctors often don't show patients their scans and patients very much want to see their scans. In fact, they hugely benefit from it. So what does co stand for setting and equipment? This is about taking the time to prepare yourself to meet the patient and communicate the results of their scans, ensure you have a private space and that your imaging and report is ready for the patient to see a stands for assumptions. Establish how long the patient has been waiting for the scan. Research has shown that there is a disconnect between how long patients expected to wait versus how long they actually waited. Acknowledge the waiting time, recognize that it helps the patient feel validated and therefore improves your therapeutic relationship. This is also an opportunity to check the patient's understanding for why they needed the scan, what type of scan they had and what they expect the results to be. Keep an open mind, be willing to be led by the patient and do not assume anything link. It's very useful to link the patient's presentation to the findings on the scan. Talk through the scan results in simple nonanatomical terms and explain how what's visible on the scan relates to the patient's symptoms. Discuss what the scan results mean. Moving forward, you can link the current scan to previous scans if that's relevant or if the scan indicates bad news, you can rely on the spikes protocol. Finally be specific, provide a clear diagnosis and explore patient perceptions of the results. Even if receiving difficult news, patients prefer direct conversations. If it is impossible to provide a clear explanation, talk about why the scan was required and how it will be used as part of the healthcare investigation. Signposted resources were available and provide closure if it's appropriate. Now, we will demonstrate the application of our protocol into the clinical setting. This is a made up case ie made up patient and fake condition. We want to demonstrate that you can apply this framework regardless of what condition or scan you are faced with. As the focus is on a systematic approach for good communication, I will play the role as the patient and Carisma will be acting as the junior doctor. So the case is a 36 year old female named Angela Briggs. She was walking through the woods in stormy weather and she inhaled something. She started coughing up fur and experienced worsening pain at the base of her right lung. She visited the GP last week for a chest X ray, but due to ongoing symptoms, she has presented to A&E a healthcare professional has told Angela her scan is fine and that's one of the junior doctors can prescribe some painkillers, charisma as a junior doctor, you have been asked to see Angela prior to discharge a prescribed medication she may need. So I've just received a handover about Angela Briggs prior to seeing her, I'm going to rely on the sales protocol and I'm going to get my laptop and make sure it has enough charge and it is working well. I'm going to pull up Angela's details and read through her recent notes, her chest x-ray is back. So I'm going to have a look and make sure that I understand it. I can see here that her scan is reassuring I know what her diagnosis is and this is a self limiting condition. I recall the sales framework in medical school. So I recognize that this could be an excellent opportunity to show Angela her scan. If she wants, we'll talk through her scan and I'll provide some safety netting advice. She may have some questions about her condition. So I'll pick up some leaflets on the way. I'm aware that there is a room available. So I'll talk to her in there to give us some privacy. My colleague has pointed out who Angela is and I'm on my way to see her. Now I've arrived, I see Angela and now I'm going to introduce myself. Hello there. My name is Karishma. I'm one of the junior doctors working here today. Can I confirm your name and date of birth, please? Hi. Yes, it's Angela Briggs. Um It's the 20th of October 1986. Hi, Angela. Um I was informed that one of my colleagues has already spoken to you, but I've been asked to see you before you head home. Shall we go into this room here? So we have some privacy. Yes, please. Thanks. My understanding is that my colleague told you your scan was fine, but you're still experiencing some pain and wanted to talk about medication. Is that right? Yes, please. Um I've been taking paracetamol but it isn't really helping. Yes, we can discuss your medication. But before that, I've got your chest X ray here with me and I wondered if you might be interested in seeing it. Oh, yeah, that'd be, that'd be very helpful. Um It's all just a bit confusing. Um My GP had referred me for a scan last week but I was getting worried because I still don't feel well. So I turned up here in A&E um, although your colleagues said my scan was nothing to worry about. I'm just a bit anxious about it all. Um And I thought I would get some answers here, but I just feel a bit lost to be honest. Oh, I'm sorry to hear. Things haven't been made clear to you, Angela. It's understandable that you're concerned in order to give you all the information that you need, it would be helpful for me to know in your own words. What brought you in? Yeah. Um Well, I've been experiencing a cough and some chest pain. Um It started about 10 days ago when I was taking a walk through the woods. I remember it was quite stormy and windy and II inhaled something. Uh It felt like a fur ball and since then I just, I've had chest pain on my right side and I've also been coughing up fur. I saw my GP last week and I was referred for a chest X ray. I see. So when did you go in to get your chest X ray? I went in the next day after seeing my GP. OK. So you've been waiting for a week. Um Was that all right for you? To be honest, I thought I would have received my results sooner. It's just been a bit tough, you know, not really knowing what's happening in my body. II understand that Angela, I'm sorry, you've been experiencing a difficult time. The reason you've been waiting as long as you have is because it takes a week for the radiologists. So, radiologists are doctors who read the scans, um, to write a report that gets checked and then it gets sent to us. Um, so we have the report here. Now, if you want to read it, we can certainly go over it together. Oh, I see. II didn't realize that. Yes, please. II would like to go over the report if it will help me understand what's wrong with me. Absolutely. Um, we can do that at the end. It would make sense for us. I think to talk to your chest x-ray first. How would you feel about that? Um, I'm a bit worried, I'm not really sure what to expect and how I'll cope. Oh, I see. Is there something in particular that's worrying you? Well, when my dad had a bad cough and chest pain, he was diagnosed with lung cancer and he passed away when I was 15 and it was a really hard time and I know that family history has some bearing on a cancer diagnosis. I'm really sorry to hear that. Angela. Um, are, are you worried that you might have lung cancer? Yes. Yeah, I am. II don't know if that sounds silly, but it's just he had the same pain and cough. Oh, it's, it's not silly at all. I'm, I'm really sorry to hear about your dad. Um, it's an understandable worry for you. I think to start with it would be helpful for me to reassure you that I've had a look at your scan already and there is nothing there that indicated lung cancer. Oh, thank goodness. I was so worried it would be cancer. That's a relief. Um But what's causing my pain and my cough then, so we found a small area of swelling in the base of your right lung and that's likely to be causing your symptoms. Would it be ok if I showed you the scan now and I can talk you through it? Yes, please. I'd like to see it. Ok. So here's your chest X ray. Um The two large outlines at either side filled with black space are your lungs? It looks black because it's filled with air. Your lungs are meant to be filled with air. So that's perfectly normal. The vertical line in between your spine, uh sorry, the vertical line in between is your spine and the Yeah. So the two horizontal lines on either side are your collar bones? Ok. Your right lung is on your left side and your left lung is visible on your right side. Is that my son? Yeah. Wow. I've, I've never seen an X ray of my chest before. Yeah. So, now, do you see the squirrel at the base of your right lung? Yeah. What's that? So, that's the collection of fur that you inhaled when you were out on your walk? This collection has caused some irritation to your lung and that's why you've been experiencing the pain and the cough. I see. Ok. I didn't know that could happen. Is there any way to get rid of the fur? Yeah. You know, it, it can and it does happen more often than you think. Um, you've got a classic case of scleritis. Now, this often resolves on its own with time. It's nothing to, to worry about. I can prescribe some strong pain, stronger painkillers to help manage the pain. Uh, but there are also steps you can take in the meantime to feel better. Yeah, I think some stronger painkillers would be really helpful. Thanks. Um What, what else can I do in the meantime? So you can get plenty of rest. Um, drink some fluids, breathing in steam from a bowl of hot water can also help your symptoms should resolve within two weeks. Um, but scleritis tends to recur in stormy weather conditions. So I would suggest avoiding the woods during that time. But if things get worse, uh, please don't hesitate to get in contact with health services again. Ok. I can do that. Uh, I won't be back in those woods any time soon. Um, you said that it can re recur. So if this happens again, do I not need any more investigations? Well, yes. If you find that you have the same symptoms after walking through the woods in bad stormy weather, then it's likely to be scleritis again. In that case, you won't need another scan. You can start treating it yourself based on the interventions we've discussed. But absolutely get in touch with your GP or NHS 24. Um, you know, if you feel like your symptoms have worsened or that you need stronger painkillers and if you're particularly worried, um, you know, you can always turn up to emergency services like you have. Ok, that's, that's really good to know. Uh, I guess it potentially saves me an unnecessary visit to the doctors because II just hate getting scans. Um, and such. So, thanks for letting me know. I can't believe it's, it's common. I've, I've never heard of scleritis before. Oh, yeah. Yeah, it is. II can give you a leaflet on it. It contains some more pertinent information. Um, but there's also a website called scleritis.org that has, um, more information, you know, if you're, if you're interested. Yeah, that'd be very helpful. Thanks. I'm seeing and talking through the chest X ray. Actually, that's been quite useful because it's helped me understand what's happening. Uh, I'm just relieved it's not cancer. Oh, gla glad I'm able to help. Um, would you like to go over the radiologist report now? Oh, you know what I think? I think that's all right. I think the way you explain things, it just makes so much sense. Um, I know what to expect now. Good to hear that. Um, do you have any other questions for me, Angela? No, I'm, I'm ok. I think you answered them as, as you went along, but thank you very much. No worries, take care. Ok. So that was an example of using the seals framework to communicate the results of a chest X ray to a patient. Although my task was to have a quick chat with the patient before she was discharged and prescribed painkillers. I recognized that this could potentially be an opportunity to show the patient her scan and use it as a basis to educate her on her condition. I recall that I could fall back on seals to structure the consultation. I will now go through each part of the framework and associate it back to the roleplay scenario that we just did. So in terms of setting and equipment prior to seeing the patient, I made sure that I had a working laptop and a private space for the consultation. I checked patient details and brought up the correct scan ensured it was the most recent scan. I had a look to understand the scan for myself and read through the radiologist report. It seemed likely that Angela would want to know more about her diagnosis. So I spent some time anticipating questions she may have and had some leaflets ready assumptions. It's useful to remember that patient's expectations and standard NHS protocol may differ. Angela had assumed that she would result, receive her results sooner. Now, it's crucial to take the time to explain to the patient why that isn't the case and why the scan took a week to come back. This helps ease any negative emotions the patients may have had and improves the therapeutic relationship with the doctor and it also improves the perception of the NHS as a whole. Another aspect to explore is any prior beliefs the patient may have about their symptoms. Patients tend to formulate beliefs about their condition based on previous life experiences, what they see on social media, what they've Googled or the lack of knowledge may lead them to jump to the worst possible conclusion to improve the consultation experience for the patient. It's worthwhile to ask what assumptions they may have about the symptoms they're experiencing. Now, we could see that Angela was very anxious, a cue that is important to pick up on and follow through her dad had lung cancer. So she was now concerned that she might have it too. I asked her directly if she was worried about having cancer to provide an opportunity for her to fully express that fear. She said she felt silly for asking that. Now, patients tend to minimize their concerns because they can sometimes worry about how a doctor would perceive them. But she has voiced and understandable fear I provided validation that it was ok for her to share that worry. I said it's not silly at all. And then I reassured her that she did not have lung cancer. It was obvious how relieved Angela was and it meant we could proceed with her being fully present and not preoccupied about what her symptoms might mean. Link one of the goals of the consultation is to reduce the knowledge gap between the doctor and the patient. One aspect of that is educating patients on what investigations they had, why they had it and what the results are. I asked Angela for consent. I asked if she would like to see her scan because some patients may not want to and that choice should be respected. If all Angela wanted was some stronger painkillers and a leaflet on her condition, then I would have respected that. But she wanted to see her scan and most patients you'll come across in your clinical practice would want to see their scans. So I proceeded to show her the X ray and outlined in basic terms, what we were looking at. We want to avoid anatomical terms like vertebrae. When spine would suffice, you can say collarbones instead of clavicles. I then orientated Angela to the image and pointed to where the abnormality was. She could see that and she expressed curiosity about it. I was then able to link the visual abnormality with the pain and cough. She was experiencing this link between the x-ray and her symptoms resulted in an aha moment for Angela. She understood what was happening in her body and wanted to know more specific. The patient is engaged in the consultation and we're on the same page about her understanding of the chest X ray. So naturally Angela wants to know how she can get rid of the cough and the pain. How can we get the girl to disappear from the scan? She asked, this provides an opportunity to offer or confirm a diagnosis. Provide some time for questions and allow the patient to share how they feel about the diagnosis. Angela displayed some surprise, she didn't know that a walk through the woods could result in scleritis. She wanted to know how to treat it, which is an opportunity to discuss a management plan. This is the time to talk about medication. And in Angela's case, we've talked about stronger painkillers and steps she could take to help herself feel better. Crucially, I told Angela that this tends to recur in poor weather conditions. And if she was to experience the same symptoms, she did not need another scan. Angela was happy to hear that she said she found scans stressful and providing this information has potentially saved her an unnecessary visit to the GP or having another scan in the future. But of course, it's very important to provide appropriate worsening advice to ensure that patients are safe. Angela indicated an interest in learning more about her condition which I anticipated and prepared for in the beginning. So I was able to give her a leaflet and signpost her to a useful website. This access to reliable knowledge can be very empowering for patients. Finally, I provided an opportunity to go over the radiology report and for more questions at the end, but Angela was quite happy and did not have any more queries. Overall, this was an example of a successful consultation where a patient came in worried in pain, unsure of what the chest X ray would mean and what to expect overall. But by following the seals framework, I was able to alleviate her worry, explain why she was having those symptoms by linking it to her chest X ray and provide an accurate diagnosis and management plan with worsening advice. So we can see scans often denote a significant episode of care and patients naturally want to see and understand what their scans mean. Illness journeys require closure. Scans may be a very stressful experience for the patient. Closure from doc from a doctor is important for patients to safely move on and discussing scans. Well, meaning patient on patients understand why they have the scan it shows and how it has been used as part of the healthcare journey can provide disclosure. Thank you very much for your time and for joining us this evening, please fill in the short feedback form so it can help us improve and to receive your certificate, recordings of this talk and slides will be available on metal. And regarding next steps, we hope to provide more content in the near future, including videos and mock scenarios that are useful for both everyday practice. And for Aussies, we're here for a few more minutes to take any questions, just pop them in the chat box or use the microphone. Otherwise, thank you again for your time and have a lovely evening. Yeah, I just wanted to say thank you as well for coming on Valentine's evening. Um and joining us on this and thank you to the people who have already dropped a few questions in the chat. I hope that what we said makes sense. If it doesn't, please either just turn on your um turn on your mics or drop another message in the chat and we're happy to try and explain a bit better. Otherwise, thanks so much. Yes, so sorry. So our event organizer's microphone is not working, so she's having to type everything out. But basically, yeah, if you would um please be able to fill out some feedback. We're planning on making some more videos on more consultations that get increasingly more complex and reflect real life situations on what a scan consultation might look like and we're hoping it would be useful for medical students, final exams as well as just getting ready for, um, and for life on the wards or if you're already on the wards, um, just to help you deal with some of the, um, unknowns when approaching, speaking about scans, but if there's no more questions, I'm not seeing any come in, um, you know, uh, have a lovely evening and I think we'll just be here for two more minutes and then we'll, um, just conclude the teaching if that's all right. Right. Hopefully you can access that feedback link and it will be again available on your med account. And even if you haven't filled it out, now, if you fill it out later, you'll still get the certificate as well. So, thanks so much everyone. And we're just gonna log off now and have a lovely evening and rest of the week.