Teamwork: working with service-users to improve the mammogram experience
Our WOMMeN project provides a unique opportunity to explore the nitty gritty of what women experience during breast screening. Crucially it encourages dialogue between the two groups in the mammogram interaction: mammographers and service users. This is helping these two parties come to a common understanding because, together, they explore what happens when things go wrong and how we might work to put them right.
Using the following real life case study from Jo Taylor, one of our service users on the research team, Julie Wray gets practitioners to reflect on what went wrong and how things could be different.
Julie explains, the following case highlights an experience that has a number of learning opportunities. It could be useful to consider in your own practice learning contexts e.g. with students and staff meetings.
It could be that the mammographer in this case study did reflect and consider her own actions in some detail, as reflection has the capacity to change practice and enhance practitioner behaviours (see: Donald Schön’s (1983) work on reflective practice)
In reading this case study we will pose some questions to aid your reflection.
I had my 6-monthly appointment with my surgeon. After being diagnosed with secondary breast cancer I have to have regular checks and a mammogram every year on my one breast that is left (not the reconstructed breast).
Everything was fine with the appointment as I’m currently in remission. She checked my breasts and surgery site so then my surgeon sent me for the routine mammogram. My hubby was with me at the appointment and went back to work as it was a formality getting this done. I was called in by a young girl who instructed me to take a seat as she needed to confirm a few questions. I was instructed to remove my top and bra and I stood at the machine waiting for the mammographer to move me into position.
Thinking back: How would you prepare this woman for her ‘routine’ mammogram?
Firstly, I’ve never heard someone be so instructive and precise with my body, move your arm, put it there, push your hip out, push your bottom out, move your foot, hold onto that, lift your arm, head to me, turn your head away, chin up, stand with your feet apart… The instructions went on and on AND on…
I actually felt exasperated.
I normally never even have anything to say but it got to the point where I was completely confused with the instructions and what she was asking of me, so I said ‘I’m confused!’ and she said, ‘sorry would you like me to just put you into position?’ I told her yes. She didn’t seem to be caring and considerate at all in her approach. Everyone who was being tested that day had secondary breast cancer therefore I’m sure she should have shown some kind of consideration for this!
Image: Flickr.com, Tanya Little. CC BY-SA 2.0
Thinking back: Is there anything here you would do differently? if so, what would that be, and if not, why not?
It was the first time I’ve ever had a ‘bad experience’ with a mammogram.
She pushed and pulled me again into the right position and then I thought my sternum where I have a couple of spots of metastatic breast cancer in the bone was going to be scraped by the machine after the compression which made me wince.
So finally we got there but she really hurt my chest and caused pain which I told her about, I said I’d never had pain before in previous mammograms and she was a bit ‘off’ and said ‘perhaps the other mammographer would be better for me’ well – I’ve never felt so exposed & useless & upset by what she had done and said! There I was stood with no top on being ‘told off’ by her. I think this new young mammographer was trying much too hard and it was very painful on my chest. This shouldn’t ever be painful.
I told her I wasn’t happy and nothing like this had ever happened before and her reply was “well perhaps you should have another lady do this next time and I’m not the right person for you as obviously you’re not happy”
Thinking back: When women express concern how do you handle feedback? What would you have done in this situation? and why?
No I damn well wasn’t!
10 minutes later I still had a red mark on my chest. I went outside and rang hubby and cried. I then walked back into the breast cancer unit and took one of the breast cancer nurses to one side and complained about what happened.
Hopefully I will not have to see her again but something like this can put women off having mammograms when they can potentially save your life.
Finally: If you were to summarise the issues in this case study what would they be? What actions would you take should this case study be brought to your attention?
These questions have been posed to mammography practitioners. However if you are a patient reading this what do you think went wrong? Is this experience something you can relate to or have all your experiences of mammography been good?
And thinking forward: here’s an important question. In the era of Social Media where people post such experiences on line, if you read this experience on a blog or forum, would you respond and if so how would you balance acknowledging this woman’s poor experience whilst managing the expectations and perspectives of future clients?
Dr Julie Wray is a Senior Lecturer in the School of Nursing, Midwifery, Social Work & Social Science at the University of Salford
Jo Taylor is creator of the hugely successful ABCD web site which provides a solid foundation for people, in the first stages of breast cancer diagnosis, to help them make informed choices about, for instance, hospitals, surgeons, and reconstructions