Radiologists’ moral responsibilities to patients and their communities extend beyond the hospital and clinic, and radiologists should consider how they can leverage their presence in their communities for the greater societal good; that was the message that Reed A. Omary, M.D., delivered on Tuesday, Nov. 30 in a plenary session at RSNA22, the annual conference of the Radiological Society of North America, which was held at Chicago’s McCormick Place last week.
Dr. Omary, a practicing interventional radiologist, is a professor of radiology at the Vanderbilt University School of Medicine in Nashville, and chair of radiology at Vanderbilt University Medical Center. He is also the author of over 200 published articles, and has obtained $7 million in grant funding for a wide variety of research projects.
Speaking on the subject “Designing Radiology for Patients, Communities, and the Planet,” Omary shared with his audience a slide that showed three circles: the smallest, at the center, was “patient healthcare”; a second, larger circle that encompassed the first, was “community health and well-being”; and the third, largest circle, which encompassed the first two, was “planetary health.” And he noted that the official theme of RSNA22 was “Empowering Patients and Partners in Care”—“that’s why we’re here,” both at the conference as attendees, and as physicians and others involved in patient care delivery.
Then, Omary showed a photo of the nearly-always-crowded security checkpoint area at Denver International Airport, and shared a story about how he and his wife and three children had arrived at DIA in March 2016, and were daunted by the lengths of the lines snaking through the security checkpoint. Ultimately, they made their flight, but felt in that moment the challenge of navigating airports. Similarly, he said, “Everyone here today has experienced the healthcare system and knows how frustrating it is to navigate. Thirty minutes ago,” he said, “I received a text from one of the chairs at Vanderbilt asking for help with a patient. Last week, I received a call from a financial attorney in New York City, who went to college with me. His mother has breast cancer and doesn’t know how to navigate the system. So I’d like to start with a video from Dr. Brené Brown, who’s an expert in empathy.”
And what Omary noted is that sympathy is a limited form of empathy, which is far more encompassing and which involves feeling with people, not just about them. “I think of empathy as a sacred space,” he said, and immediately asked, “Is radiology designed for sympathy or for empathy? We can expand that to encompass healthcare. So much of healthcare is designed to meet the needs of physicians, not patients. So I want to talk to you about one way we can start doing that, how we can move from sympathy to empathy, how we can move from the maze of healthcare to making it amazing healthcare.”
One key element, Omary said, will be in leaders investing time and effort in developing human-centered design, which is also design thinking, and which was “a process started in the late 1980s and early 1990s in California, inside a consulting firm called IDO. It’s become mainstream in any industry doing design. It’s now found its way into healthcare. And it starts with empathy: understanding the needs of humans. How does healthcare traditionally define problems? Data: show me the data! Let’s start with people before we start with spreadsheets.” The key steps in any human-centered design process, he noted, are as follows: empathize / define / ideate / prototype / test.
With regard to how human-centered design plays out over time, Omary emphasized that “It’s a constant process of iterative design. We need to bring a diverse group of people to help us co-design a solution. It never ends.”
Indeed, Omary noted, he and his colleagues came together recently, leveraging what they’re calling “empathy mapping,” in which the participants sit together in meetings and scope out what kinds of improvements might benefit stakeholders the most. In that work, he said, “We brought together radiologists, techs, nurses, students, community members. When we start with empathy, we can define the pain points in the journey.”
In that context, Omary and his colleagues in the Radiology Department at Vanderbilt University Medical Center agreed on several “health equity big ideas,” namely:
Ø Understand the patient population
Ø Emphasize the importance of empathy
Ø Share patient experiences
Ø Develop an accessible curriculum
Ø Include health equity experts from outside radiology
Ø Understand the learning needs of trainees.
Out of that, Omary said, “We developed a health equity program for all of Vanderbilt U Medical Center. We developed a series of micro-grants where we would seed initiatives with micro-grants. Unfortunately, Dr. Matthew Walker III passed away during COVID. He comes from a family of community and HQ activists. We opened the Dr. Matthew Walker III Health Equity Lectureship. So, very tangible efforts came out of that design session.”
And, per that, Omary went on to say that “We have so much opportunity to make changes in healthcare that improve the patient experience, as the theme of this entire meeting [RSNA22] reflects. When an individual walks into one of our imaging centers, they are a patient. When they walk out, they are a community member. I’d like to focus on how we can expand outside the confines of the healthcare system, and focus on community health and well-being. When we step outside of those confines, health and well-being. Most people spend their lives outside healthcare, and seek the care when they need it. That presents an opportunity for us to promote the health of people. Subsequently, improving the health and well-being of communities. Outside of those confines, our patients become global citizens.”
In that regard, Omary said, “We can expand what radiology is by promoting the arts, sports, play an important role in our kids’ schools. I’m helping our local school develop a strategic plan. We can promote culture through restaurants and other opportunities to allow people to connect with each other in different ways. And through philanthropy. We as radiologists are fortunately highly compensated. We can give back to our communities, to the RSNA Research and Education Foundation. And we have the opportunity to participate in some of the religious traditions, if we are so inclined.”
And, importantly, Omary went on, radiologists can get involved in the effort to reduce the environmental footprint of the healthcare industry. We can address planetary health in radiology. The World Health organization has stated that ‘Climate change is the single biggest health threat facing humanity.’ But unlike with COVID, there’s no vaccine for climate change. We have the opportunity in radiology to transform healthcare and the planet. Per that, he noted, “The Paris Agreement of 2015 recommended we limit the rise in global temperatures from 1.5-2C. We’re already at 1.1C. HC itself is an important contributor to greenhouse gas emissions. If healthcare as a sector were a nation, we would be the fifth-largest emitter of greenhouse gases. We have a lot of responsibility and a lot of work to do. Also, climate change costs $2 billion a year in costs—smoke inhalation from wildfires, diseases caused by flooding or tick-borne illnesses. We in medicine, physicians and nurses, are the most trusted profession in the world. We have earned that trust; we cannot betray that trust. Our patients and our community members expect us to be on top of things that will affect them. It’s not just our opportunity, it’s our responsibility, to address planetary health, since it will affect community members, disproportionately affecting those without access to resources, so this becomes a health equity issue.”
