Establishing Patient Rapport During Mammograms
By: Stacey Nester
You never know what might be going on inside of a woman at the time of her mammogram. Therefore, in order to create positive patient rapport, each woman should be approached openly by the technologist with the awareness that she may have concerns that extend beyond the fact that her breasts are about to be made into pancakes. It seems that this less than modest exam brings to surface other emotional concerns that may be causing distress in a patient.
Sources of a patient’s emotional concerns that a technologist should consider are:
- Family history or a perceived high risk of breast cancer
- Personal experiences with friends of relatives
- Inadequate or too much information, even misinformation
- Ongoing controversies and changing recommendations
- Other unrelated life stresses
If the technologist comes to the exam aware of these possibilities they will find they can diffuse the anxiety more readily by providing comfort and avenues for them to find some needed answers. This will result in the patient trusting the technologist, aiding in a positive rapport.
A technologist’s tone of speech, facial expressions, and body language will all contribute to the rapport you create with each woman. Good patient rapport is probably the your best bet for getting the best possible images. To put it bluntly, if a woman is relaxed, you will be able to pull her breast away from her ribs and compress adequately. You will never get adequate compression with tight muscles. Technologists should just assume that it doesn’t matter how many mammograms a woman has had, there will always be that little bit anxiety that creeps in either as soon as at the time of scheduling or as delayed as when the paddle is coming down on their breast for the first image. A good technologist will learn to read the level of anxiety a woman is experiencing. They will give the woman a sense of respect and control over the situation by listening to their opinions and allowing them to express what they might be feeling. It is good practice to attempt to diffuse any anxiety the moment you call the woman’s name in the waiting room.
Your personal presentation sets the stage. Be sure you dress neatly and professionally. Your hair should be clean and tidy, as well as your finger nails. Look like someone you would allow to tug and pull on your breasts! Approach every woman with confidence. Hold this confidence throughout the exam. If they are confident in you and the work you are about to do on them, they will be more inclined to relax.
Greet every woman with a smile. After you call her name and she rises, escort her out of the waiting room before you ask anything else. The waiting room may be filled with many other people waiting for a variety of other exams. This will show them you are protective of their privacy. Who knows, they may know someone waiting for another exam. Outside of the waiting room check her birth-date. This serves two purposes. The most important is to make sure you have the correct person. The second is to instill in the patient that you are a professional and are careful about the work you do.
Introduce yourself and explain that you are the technologist that will be taking her pictures. Next, change the subject on the way to the Mammography Suite. Interject a little humor if it seems the woman would be open to it. Even referring to the exam as your torture chamber, with a smile, may get a laugh and ease some tension since that is probably what they would like to call it anyway.
Once in the exam room, back to business, make a point to tell the woman that no one can come through the door. It is locked or there is sign on the outside the door alerting all others that an exam is in progress. Again, change the subject, ask a question that is totally unrelated to the exam you are about perform. Allow the patient some time to respond and even expand upon her answer. You may find out something about them that you can continue to discuss through out the exam. You might even clue into what they are wearing. This could be a local sports team sweatshirt or a pair of really cute shoes! Comment on how the team has done recently or compliment their shoes or maybe their jewelry. Any of these sorts of conversation openers will take their mind off of what is about to happen to them and start a discussion that can be carried on throughout the exam. It is amazing how many awesome stories about special pieces of jewelry you may hear. This little bit of time you spend on this is time well spent as it will help the exam go more smoothly and quickly and will result in optimal images.
As you are talking casually move the conversation again back to the task at hand. Ask them about their breast and family history. Make sure their current contact information is correct. Discuss where their prior mammogram was done if it was not done at your facility. Take a professional role as you ask these important questions. Position yourself, whenever possible, at eye level with your patients. Healthcare providers who sit are perceived to spend more time with their patients than providers who stand for the same amount of time. This is when you will ask if they are having any symptoms. Let it be obvious to them that you are listening to her answers, nod your head and make notes on their paperwork. Try to maintain eye contact and keep an eye on their body language. If they start to look anxious offer a piece of information regarding their symptoms that may ease their mind. Show interest in all that they offer even if they momentarily get off topic. Maybe they have recently moved and add a bit about how much they love their new home. This is a positive, happy thought that will take away from any anxiety that has begun to creep in again. The little extra time spent here is well worth it, because now it is time to get down to business!
With gown in hand, which you may have picked up as you were continuing conversation, instruct the patient to undress waist up putting the gown open to the front. Address their jewelry. Let them know you have wipes for their use if they used deodorant, perfume or powder in the breast area. If you do not have wipes, water and paper towels will suffice.
As she exits the dressing room greet her again with a smile and pick up the conversation you began earlier. Let her see you wipe down the machine, wash your hans or use hand sanitizer and put on your gloves. Guide her gently towards the machine. Your tone may change to a more calming one. Do not seem to be in a hurry, even you are a bit behind. It is possible to lead a patient quickly through an exam without her even knowing it. Explain what is going to go on. Let her know that the exam will be uncomfortable but if at any time during the exam she experiences anything unbearable to let you know. Tell her that you may be able to adjust things to make it more bearable. This relinquishes some control back to her and eases anxiety. Proceed with the exam with your “get her mind off the exam” conversation. Interject instructions as you chat. Use your free hand to gently guide her into the position you need her in. Remind her to continue to breath.
It takes practice, but learning to actively listen while still guide someone through the motions of preparing for and having a mammogram is possible. Perfecting this creation of a positive rapport will help you instill confidence in your patients which leads to acquiring the best mammogram possible with each individual woman.