Chat and experience of breast X-ray, breast screening mammogram

Julie Stein Hodgins, Mammographer

Julie Stein Hodgins, Mammographer

Hello My Name Is…  WoMMen Forum Chat

Here we introduce the story of an online WoMMeN Forum Chat that we held on Sept 7th, 2016. The theme of the chat was our experience within breast screening of the Hello My Name is… campaign.

We have 7 themes, all grouped together, the comments from the eight participants have been anonymised, but each comment starts with the # symbol.

Thank you for having a read and feel free to add your own comments below the post – mammographers, share your experience implementing this campaign, comment and join in on the forum!

Julie Stein Hodgins. Mammographer.


 

Attribution: https://www.flickr.com/photos/lamailloux/11563052893

Attribution: https://www.flickr.com/photos/lamailloux/11563052893

Communication, manner and tone

#I might start in a controversial way. The best experience I had was from a mammo who was very professional but did not communicate with me at all except to tell me where to stand and what to do. I had every confidence in her assertive manner!

# Thanks..is that a good thing? An assertive manner?

# Did the assertive manner make you feel nervous? Tense?

#No it gave me the confidence that she knew exactly what needed to be done. That’s what I need when I go for a mammo

# I think a professional manner is important and does inspire confidence but I think introducing yourself is also very important

# That’s great. So is it the manner of the health professional that gives you confidence in their skills? DId you feel you have control of the procedure?

# She might have introduced herself but that’s not the lasting impression (I’ve forgotten what her name is even if she did tell me). I didn’t particularly feel in control but I didn’t mind. I wanted her to be in control. Is that a bad thing?

# Thats is good. The assertiveness is due to the very precise way we like to see the breast images. We have to think about the nipple, the pec, lateral medial borders and many more all within 6 mins!

# I don’t initially use assertiveness..I’d rather engage with the woman and let her know that she has control over the procedure..well at least we can negotiate..and of course she can say ‘no’ at any time. I often hear people talk about..and the jokes..all imply the squish flattens your breast and they do not realise that I am controlling the pressure.

# Yes definitely ,professionalism is important and a great way is to break barrier between the client and the Mammographer is to introduce yourself with a smile of course and this usually relaxes the client ready for the mammogram


Image of lots of clocks

Time…

Time

#So time is not an issue?

# Time is always an issue, but I’ve got the patter down to a fine art now!

# I agree, it can be done. By taking the time to explain it pays off as the lady becomes more cooperative which helps loads!!


https://commons.wikimedia.org/wiki/File:Body_Language.svgAnticipating what works best for the client

# Can I ask was this your first mammo? Do you think you would have felt the same if this was your first time?
I am a Mammographer and I always find ladies need some level of connection, be it a smile or sometimes more. In our role I believe we become skilled in ‘reading’ what a lady needs. Even if like in your case it is to be a minimal professional approach. What do others think?

#  # No it wasn’t my first – you’re quite right, and being a radiographer myself I knew what to expect. You sussed me out!

# Yes part of the skill of the job is reading what is required in a given situation!

# I agree. Although, we can fall into the trap of sounding like a recording,especially when screening!
With tight times I think we risk being more minimal with communication anyway and I’m sure most women prefer to get it done as swiftly as possible. How many times in contrast do we also hear, ‘thanks so much last time I felt like a piece of meat’ not very often but, it makes you ponder. For, the lady to recall the last mammo in that way from 3 years ago?!

I believe our tone and manner is what makes the examination (and skill of course) And, yes our name and introduction is important, it sets the scene and keeps us in control of the examination

# Great comments,

# I’m not saying it’s not important to introduce yourself but I think technical ability was more important to me then. This is completely the opposite to what I teach students though!!

# Friends of mine experienced breast x-ray..but the mammographer forgot to explain to first timers what was going to happen. They will attend again because they feel that is what they have to put up with.
How many of us take the time to explain or is the 6 minute rule to tight?

# I give a brief explanation to everyone, but a more detailed one to first timers and always check if they have any questions


Symptomatic vs ScreeningCancer cell small

# Do practitioners change their manner when imaging ‘well women’ (ie screening) and then when imaging women with symptoms or recalls? Do the latter group need a different approach?

#  Yes, I think all the various groups of women who attend for mammograms need a different approach. There are family history women and those who have had breast cancer previously as well

# I find that more time is required for non screening patients/Clients..may be just a gentle touch on the shoulder or arm to relax the patient works wonders! And possibly reassures the patient/client

# I agree totally with you , I have always I hope, introduced myself..we are engaging with women who can be nervous about the procedure or outcome..or are not bothered..but I xray women, not breasts! A smile goes a long way to helping ‘read’ her. However..I believe that not all women get a good enough experience. and when they do they need to be reminded to tell their friends!


 

https://www.flickr.com/photos/gaylabaer/10960458656What experience we see clients reporting online

# So a tweet from today;..I’ll quote it..’’Had talk thru #hellomynameis after my Radiology appt today as it was absent Radiographer had heard of it & forgot  Said TY for feedback ’’  

# So patients/ clients are starting to pick us up for not introducing ourselves. 

# My experience of a mammogram last year – I didn’t inform the mammographer who I was and she obviously had no idea who I was which was great. She introduced herself by name and I do remember her doing this; though couldn’t remember anything she told me as I was one of those ‘patients’ who forgets their name as they walk through the door! She was very assertive , confident and it put me at ease as I could tell she knew what she was doing.
As a previous mammographer I agree with you , connection is the key – a smile definitely goes a very long way. I also believe this confident and skilful approach is the key too.

# Any clients/women/patients out there who can tell us what they think?

# Friends of mine experienced breast xray..but the mammographer forgot to explain to first timers what was going to happen. They will attend again because they feel that is what they have to put up with.
How many of us take the time to explain or is the 6 minute rule to tight?

# Posting online with your name and profession is a good idea if trust policies allow you to do this. What do others think?

Other reviews

# Been cheeky and just copied this from Patient Opinion website (about Aberdeen breast screening) – note she mentions being told the mammogs name – so patients do notice

I attended last week for my annual mammogram following breast cancer treatment in 2010-11.

I wish to thank the radiographer for her kindness and professionalism- this is an extremely painful process due to scar tissue and other issues in the affected breast, it’s also an anxious time as there is always a fear of recurrence of the cancer. the radiographer saw me on time, introduced herself, and made the procedure as quick as possible whilst ensuring that the imaging was correct- she was reassuring and obviously had empathy for what I was going through.

I received my results this week directly from the breast care nurse- the quickest that I’ve ever had the results from a mammogram- which again has cut out a great deal of anxiety. Happily the results showed all was fine.

# Here’s another about Conquest – Hastings. perhaps as well as your name you need to say you’re a mammographer. THere are several comments on the Patient Opinion site about mammography where the mammographer isn’t ‘titled’

Very well-run, extremely efficient as well as friendly clinic. Registrar, consultant radiologist and mammogram clinician all patient, kind and reassuring during a difficult time. If only all clinics were this well- resourced and staffed.

# Yep not one of these patients used the word mammographer. Here’s anotherhttp://www.pallimed.org/

I visited this clinic yesterday for a consultation.

All staff were amazing. Kind, considerate and polite.

Especially the member of staff who operated the mammogram.

# Even when I introduce myself as a radiographer or mammographer I still often get ladies saying “Thank you nurse” on the way out!

#This is interesting (Ayreshire)

Having had two less than positive experiences during mammograms at local hospital, it was with trepidation that I attended the routine screening appointment at the mobile van in Ayr’s Asda car park.

I can’t say how relieved I am to say that it was a totally positive experience, made very easy by a fab radiographer ..

She was informative, chatty and clearly excellent at her job. What I was dreading turned into something akin to a chat with a friend. She’s an asset to the NHS. If only all radiographers were more like her!

# They are good examples of practice everywhere..but not enough shouting out about it. As a Mammographer, I get ‘graded’ by my boss by how high is the number of poor quality images..which are few, I might add, so we each find a way to support the woman to help us. It is the poor experiences that are remembered and shared. Thankfully Lesley is finding us the good ones. I ask clients to post online..but few do.


 

Questionnaires/Interviews

Attribution: http://southfloridatrials.com/?page_id=326

Attribution: http://southfloridatrials.com/?page_id=326

# Different centres work slightly differently, some interview the clients prior to the mammogram in a separate room whilst others have questionnaires sent with the invite and some explain the procedure in the xray room with the client covered.

Personally all have the different approaches have advantages and disadvantages.

# An interview about their clinical history, or a questionnaire? We have a questionnaire to save time in the room so that we can spend more time on the image; this is the hope – but is this friendly enough?

# Questionnaire many clients will forget!

# questionnaire for me

# Just saying things like “you had a mammogram with us 3 years ago – have you had one anywhere else since then?” is better than asking “when did you have your last mammogram?” as it saves the client from having to search her memory and saves us time!

# We use questionnaires, we do double check the answers in the room. This is done in a statement summarising their answers. This works well but, many don’t complete before arriving. Again, allows control and leading swiftly to the mammo

Chit Chat/ a way of putting the woman at ease

# Chit Chat I find that unfortunately I can’t do chit-chat whilst I’m imaging for a few reasons:

I need to get the position correct, and I like to explain not only where I want the clients to stand but also why, what I’m trying to achieve and I also can’t risk anyone talking back to me when the image is being taken or our incredibly sensitive machines blur the image  sad times.

# ..asking them to hold their breathe works..

# yes I’ve altered my practice as digital mammography came in; I never used to bother for the CC views (top-to-bottom pics, y’all) but I do now for the whole lot. However, if I’m chatting to someone and they’re chatting back, I find my incredibly English-let’s-be-polite culture comes to the fore and i’m waiting for them to finish before I interrupt and ask them to hold their breath.

Terribly awkward when their breast is under compression, mind.

# I do know what you mean and also, after a mammo myself, I think I may find chatter a bit annoying. When you’re stood there half naked you really do want it over with swiftly and professionally.

#True , I reckon..if I can get a laugh or a smile..I’v given a quality experience. I often say that no matter who comes thru the door we have to get a grade A image. We all have our ways to do this. Breast screening was set up originally to follow the Blood Bank..system..invite, you can if you want system..we believe that breastscreening relies on the ‘word of mouth’ . We meet many women with many friends that are influenced by one experience. I am not concerned about posting on line. I am a registered professional anyway!

# Obviously the chatter would have to be incorporated in to the art of positioning

# Can mammographers predict which clients would prefer a chat or non chat?

# TIME Time is always an issue isn’t it yes but I think as you say with experience you can get the patter down to a fine art – the art lies in making the patter not sounding like a recording. These are really useful comments for my new trainee mammographers next week 


 

The Royal Society for Public Health and Public Health England have released the ‘AHPs and Healthy Conversations’ reportEasy Health messages….

# The chatter could include health messages Public Health?…what are your thoughts?

# Oh noo!! It is hard enough as it is. How about, leaflets and posters on display? Be nice to have a coffee and chat area.. ?! I feel is hard sometimes to give some ladies the extra time they need.
I agree is an opportunity Shaheeda that maybe we don’t fully utilise

# What sort of messages? I would think some clients could take things very personally so could be tricky!  

# It’s what AHPs are supposed to be doing now. Making Every Contact Count

# Health message can be totally breast related..I can ask..Do you know how to check for what is normal for you? and give a leaflet. We have leaflets about cervical and bowel screening as well. Maybe we could share public health messages next time here?

# Public health messages could include info about smears, i have been asked many times regarding frequency of cervical smears and who to contact? Any of the other breastscreening staff been asked?

# I think these sorts of Public Health messages are much more appropriate than raising issues about weight and smoking which is what has been suggested

#Yes definitely, we should have posters and leaflets so we can AT LEAST direct the clients

# Yes I agree, much easier than talking about weight etc!

# Gosh ,yes, Public Health messages too. Good call there, I recall being asked that question myself! Leaflets to hand out would be helpful, and I really should know my onions when it comes to other forms of screening.

# Let’s leave Health messages to another chat..it would be worth us all having a look see and what we think our colleague could do. Yes, Lesley is correct….we should all be doing it!.

Thank you all for coming on this evening and we will look forward to seeing you again. Watch this space for a blog about tonight,

# To be honest, we do it already to a certain extent. Referring ladies back to GP if ongoing concern. Be it breast or other health issues, we are easier for some to open up to. Hearing us signposting them can be empowering for them to take the next step. Interesting challenge More leaflets and resources could encourage AHP to do this

Online Introduction

# What about introducing yourself to clients online. Some of the mammographers we’ve worked with aren’t prepared to do that. Is it the same thing?

This looks like another topic!

Thanks for taking part or just having a read..please join in the conversation.

 

 

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