All posts by leslierob10

Porkies: Whatsapp healthy eating group

Ok, so you’ve heard me talking a LOT about wommen.org.uk  as an innovative way to use Social Media (SoMe) in #breast screening. But I’m not going to bang on about WoMMeN today.

Here’s a SoMe community with proven positive health outcomes; our Whatsapp group, PORKIES.Porky logo

About 4 years ago Lynn (my big sis) and me, we decided we’d had enough of constantly battling to get to our ‘ideal’ weight. It seemed it had been a lifelong struggle. Although neither of us was obese (well, ok, bordering) we never quite felt happy or healthy.

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Me and Lynn

We decided to have our very own group which we aptly name Porkies, and set up a Whatsapp group: she’s in Eastbourne and I’m in Manchester so we had to do it online. We also thought we’d have a bit of competitive fun; there’d be a prize and trophy for the winner at the end of 10 weeks. We invited some more family members and friends to join us. We thought it’d run for the 10 weeks. Well that was four years ago and now we’re hooked! It’s the only time I’ve ever managed to keep my weight constant at a healthy figure in my life.

Here’s how it works.

First we declare our target for the 10 week period. This could be to lose a lot, lose a little or to maintain (depending on each member’s starting point). Every week we have to either lose weight (if our overall aim is to lose) or keep the same (if we’re at target and need to maintain).

Every Friday we get weighed and take a picture of ourselves on the scales (up to the knees only!) and post it on the group.

weights final.jpg If we don’t achieve our goal for the week (i.e. we’ve stayed the same or put on weight if we’ve said we’ll lose) we get a dreaded penalty point for the week.

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The coveted Porkies Trophy

The winner is the one who’s achieved their overall aim at the end of the 10 weeks with the fewest penalty points. Each member sends the winner £20 and, more importantly, the winner receives the coveted Porkies Trophy.

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A graph from the early days of Porkies when there were just 5

The wonderful Shaz records it all on the spreadsheet and posts for all (in the group) to see!

 

So how have we done? Well, this last period (May – July, 10 weeks) we lost 6 stone 2lb between the 13 of us. That’s an average of 6lb.6 which doesn’t sound too much but a few of the group are on a maintaining regime so intentionally haven’t lost.

Some have lost more than a stone!

But Porkies works because we post much, much more than pictures of our scales; this is where the social media element adds that important dimension.

We support, share recipes, post hundreds of images and videos of food (and just about everything else) give advice, (e.g. one week the group solved one member’s dilemma about whether to wear a hat or fascinator to a wedding) and scrutinise the weekly chart.

food
The many recipes we’ve shared

meme 3.jpgAnd the funny thing is that apart from me and Lynn, we don’t know what most of the other 11 ladies who’ve joined along the way (friends of friends) look like except for their feet!

In these days when we hear so much bad press about social media we thought you’d like this light-hearted and very positive story about the benefits online communities can bring. It’s so easy to set up too and we’d encourage other groups to try the same.


Oh, and just because I can’t resist the opportunity to Make Every Contact Count I did post this along the way…the benefits of a healthy diet for reducing the risk of breast cancer!message 1

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Breast Screening Benefits and Risks: joining the dots

Last week I attended the brilliant Symposium Mammographicum. It was my first attendance and I wasn’t disappointed. It somehow managed to appeal to the wide ranging audience of practitioners from all four tiers, researchers, and radiologists. The speakers came from all these groups. The poster section was superb and to top it all, I was delighted to find that my own presentation on the WoMMen breast screening hub was highly commended.

For me, though, most anticipated was the session about the benefits and harms of breast screening delivered by a panel of world-renowned experts in the field. I was hungry for information to put onto the WoMMeN hub. I therefore tried to listen to the speakers as a member of the public would; what information would I find useful to help me understand breast screening?

Dot to dot
Dot to dot? Solution below.

Individually, each presentation was expertly researched, prepared and delivered. I was enthralled. But this session also left me frustrated. Across the four talks there seemed to be some obvious solutions to the problems they had identified. However, as is often the way at conference, there was little opportunity to join the dots: I left with an urge to join do some dot-joining of my own.

Dot 1: risks versus benefits

Professor Stephen Duffy provided an excellent comparison and summary of a number of high profile breast screening evaluations. Each of the evaluations aimed to review risks versus benefits in an attempt to answer the million dollar question: is breast screening effective? Each had used similar types of data yet each had arrived at different conclusions. These contradictions had always confused me.  What Prof Duffy did was to unpick the methodologies to demonstrate that the differences in findings were not as extreme as first appeared. The balance, concluded Prof Duffy, appears to lie in favour of screening.

Fabulous, now I understood and this will help inform my own personal breast screening decisions. But I wonder about the breast screening population at large? Who tells them? They remain confused.

Main_page_of_The_Social_MEDia_CourseDot 2: patient information

Dr Kate Gower Thomas demonstrated that breast screening up-take started to decline around the early naughties. She suggested this might be because of poor information, showing women prefer word-of-mouth experiences of friends and relatives and on-line resources to evidence-based Breast Screening Programme information leaflets. Dr Gower Thomas argued these sources can potentially misinform, e.g., sensationalised accounts of breast evaluation reports by the media. Social Media (SoMe), might also be a contributory factor with women sharing negative stories of the harms and risks of screening.

Excellent; 2 dots were coalescing in my mind. If women are as confused as I had been about the contradictory reports and yet they had no eminent professor to help them make sense of this information it is possible that Dr Gower Thomas was right.  Women need someone like Prof Duffy to put it in lay terms and post on SoMe. We could use SoMe as a power for good!

breast-leafletDot 3: informed choice

Regardless of how the risks are explained though, a woman’s decision to attend breast screening depends on her attitude towards risks and benefits. This was the focus of Dr Ruth Jepson’s talk. Her message was that in this era of informed choice the aim of screening programme information should not be to increase uptake. Instead we should aim to provide high quality information and respect a woman’s choice, whatever that may be.  Balanced information means highlighting risks and benefits in equal measure, something that has been done in the latest version of the BSP “Helping you decide”    information leaflet. The problem is, as Dr Gower Thomas had shown (dot 2 starting to join up with dot 3?) women don’t read information leaflets; they go to on-line resources where the balance of information appears to favour risk.

So, could this emphasis on risk be a reason for decline in uptake? Someone asked the panel a similar question: if informed choice is the aim, should we do away with uptake figures? A few dots were being joined but swiftly erased when it was explained that a specific uptake target is necessary in order to demonstrate ‘population advantage of benefit versus risk’. Conflating population-based medicine with individual-based care and patient choice is not helpful for clarifying aims because it appears interventions to increase uptake (playing up benefits) can be at odds with those which encourage choice (identifying risks). From the audience’s response this has also led to confusion in the workforce about whether their role is to promote breast screening or not.

CVsv089WEAArgk6Dot 4: AHPs and public health

Linda Hindle spoke about the role of AHPs in public health. The audience was in agreement; this is a role for us. This was encouraging and reflects the fact that mammographers work in a screening programme which uses ionising radiation; these are explicit items within the ‘Health Protection’ domain (one of four domains in Public Health England’s definition of public health). Mammographers could be instrumental in communicating information about breast screening to the public.

But Linda’s emphasis was on the other domains such as Health Improvement: obesity, smoking, fitness and exercise. Her message was that mammographers, like other AHPs, should be Making Every Contact Count : i.e. talk about these things during your encounter with screening patients. A delegate asked wryly which of these she should key into in her 5 minute client encounter as she wouldn’t have time to cover them all. Couldn’t mammographers be doing public health activity related to breast screening to address some of the issues in dots 1, 2 & 3?


So four really inspirational dots in their own right but which cry out to be joined – here’s my attempt:

  • Women need balanced and comprehensible information to make informed choice, and need to be able to identify misinformation.
  • Misinformation and negative stories have the potential to impact on breast screening up-take.
  • For informed choice, risk information needs to be given but in a non-sensationalised way.
  • Women prefer word of mouth and on-line sources, including SoMe, to written leaflets.
  • Online sources and SoMe networks can create and perpetuate misinformation and negative stories of risk in a sensationalised way.
  • Health professionals and researchers have the knowledge and skills to distinguish information from misinformation.
  • SoMe is a powerful and dynamic form of communication that won’t go away. If this is where women go to share information we need to go there too.
  • Mammographers, like all AHPs, are encouraged to embrace a public health role.
  • The power of the internet and SoMe networks could be used to engage practitioners in this emerging public health role to direct women toward balanced and high quality current information.
  • Researchers should be enabled to write summaries of their work for the general public and share using SoMe.

If we don’t find a way to share research findings with the public in a format they understand and in a place where they access information, the purpose of the research remains solely to serve the research community and those who write evidence based policy. Women will continue to access information interpreted by uninformed others and individualised care based on informed choice will be a dot not joined.

Les 4  Dr Leslie Robinson, University of Salford


 

Call to action

Do you think there’s a role for professionals to get on-line to support patients struggling with the morass of health care information?

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Solution! Did you get it?

The WOMMeN hub

HubAfter over a year of collecting information from women through surveys, focus groups and a private Facebook user design group (100+ service users and practitioners!) our WOMMeN hub is finally ready.

It contains all the features women told us they would want in a breast screening information and social networking space. It is intended to complement the NHS Breast Screening information which is the official documentation about the Breast Screening programme. However, WOMMeN provides an alternative approach to finding out more about breast screening by hosting a social space to chat to other women and practitioners. There are also feeds to our Twitter and Facebook pages just in case these are you preferred social media platforms.

The WOMMeN hub also provides a place for practitioners to share information and practice tips through a separate practitioner forum. We do hope you will join us and also provide feedback on how the hub can be improved.

The WOMMeN team would like to thank all the wonderful people who have worked with us over the last couple of years to ensure the site is ‘by the community for the community’.

For action: See you over there (and please share with your friends)!

Les 4

Dr Leslie Robinson, University of Salford. WOMMeN project Leader

Some information about your mammogram

Part of the WOMMeN project involves providing breast screening clients with information about their mammogram. We have been asking our client reps and mammographers on the project for commonly asked questions. One of the mammographers, Geraldine Shires, has reflected on her experience of advising women on a daily basis and has come up with this check list.

“From the questionnaires which have been received it appears that a lot of women would like some explanation of what goes on when you receive an invitation for breast screening. I have worked in mammography for over 25 years and have also had breast screening myself, so here goes!

First of all, when you receive your invitation, DON’T PANIC! The chances are that even if you have heard some horror stories, it won’t be as bad as you think. The appointment time you receive may seem peculiar, for example 9 12 am. This is because each person has a specific time slot, so if you can keep to this we would appreciate it even though it may seem a bit strange! If you are running a bit late it usually isn’t too much of a problem although if if you’ve missed your time slot and it’s very busy you may have to wait until we can fit you in, or in extreme cases you might have to reschedule.

Before you come for screening there are a few useful things to know:

  1. The mammographer will ALWAYS be female
  1. Try not to put body lotions or cream on your breasts. This makes them slippery so it’s more difficult to compress them.
  1. Talc should be avoided if possible as it can sometimes show up on the images.
  1. If you have long hair it’s a good idea to bring something to tie it back with.
  1. Also tops and skirts or trousers are a better option than dresses. You will have to undress to the waist so dresses can be tricky!
  1. If you tend to have painful breasts, a couple of paracetamol before you come can help. If they are painful just before your period and that’s when your appointment is, you can rearrange it for a better time in your cycle.

Breast screening can take place either on mobile units or in static sites such as clinics or hospitals. When you get there, you will be interviewed by a member of staff who will check your details and also check if you’ve had previous mammograms or any breast problems.

We don’t receive any of your medical history so if you have any issues you think might be useful for us to know it’s good to inform us. These could be things like frozen shoulders, pacemakers, breast implants etc. Things like claustrophobia are useful for us to know about too! There have been several occasions where I have shown someone into a cubicle and when I’ve opened the door on the other side they have been quite distressed but we can’t do anything if we haven’t been told about it!

We do get asked about providing gowns. I think cost and logistics of providing enough gowns for all the screening patients would make it fairly impossible but you can always slip a jacket or cardigan over your shoulders while you’re waiting to be called through. We do try and ensure that you’re not waiting too long in the cubicle however!

After being called through into the x ray room your details will be checked again. Then usually four x rays will be taken, two on each breast. One is taken where the breast is compressed from top to bottom and one where it’s compressed from side to side. The compression will feel tight and generally uncomfortable but most people don’t find it too painful and the discomfort only lasts for a few seconds while the exposure is being taken. If you are aware that you have some soreness or a rash under your breast it’s a good idea to make us aware of it so that we can be extra careful to avoid any splitting in the skin if possible.

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Sometimes we have to do extra images. This doesn’t indicate that you have a problem. It’s usually due to movement or a positioning error. You will probably see the mammographer looking at the images on a screen but this is to ensure that nothing needs to be repeated before you leave the premises.

After the x rays have been taken you will be free to get dressed and go. Hopefully the whole procedure will have taken less than 30 minutes, unless the unit has been extremely busy. You will be given notification of when to expect your results, and hopefully you won’t have to see us again for another three years!”

Do you think Geraldine has covered all the relevant information? If you are a mammographer, do you have any other commonly asked questions you would like to add? If you are a client/patient/service-user – are there any other things which you are concerned about?

Facebook: open or closed?

I’m a member of a great Facebook group for radiographers. It boasts 4,224 members from around the world: a pretty impressive number. Many of my own clinical and academic colleagues and students are on there. The content is varied and can be very funny. Posts are rife with that radiographer black humour we used to share whilst standing around the processor; those 3 minute snatches of conversation afforded to us in the film processor days of the 80’s (showing my age now). With the advent of CR and, worse still DR, instantaneous imaging has resulted radiographers having to resort to on-line spaces to gossip. This Facebook group therefore fulfils all those desired qualities of an on-line community that Social Media purports to do.

Peachy… but there is a problem; it’s a ‘closed’ group. ‘Closed’ might suggest that any topic is ripe for discussion, and that posts will never be seen outside the site. But a closed Facebook site such as this lulls us into a false sense of security with the promise of privacy and security. Unfortunately this is not the case, ‘on-line’ is not a substitute space for the processing room.

No on-line spaces are private or closed because they comprise written text and any written forms of communication are vulnerable to exposure be they letter, email or ‘closed’ Facebook group posts. Just by example, I have previously had to investigate a screenshot of a student’s unprofessional posts, on a supposed ‘private’ Facebook site, sent through the mail by an anonymous person. This must have been sent by another member of same group. So it is quite easy for someone to print off or even share a post on their own page, in innocence or with malicious intent, and it thus becomes public. We should therefore always have this at the front of our minds and only ever write/type anything we would be happy to voice in a public space.

On the radiography Facebook group however, there is the (very) occasional post which misses this point, the content being less than professional; including derogatory comments about patients or other health professionals. These posts are disappointing. I worry, not only for the author, but also the rest of the community. How should we react to these posts? Options are ‘a) ‘like it’ – it might be funny; b) ignore it; c) comment on its inappropriateness; d) report it!

Here’s the concern. The HCPC Standards of Conduct Performance and Ethics Standard 13 states

“You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession. You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession1

HCPC standards

Having made the case that all posts are essentially public, it is clear that the author of any (very occasional) unprofessional post is breaching standard 13 (assuming they are UK radiographers – radiographers from other countries please look to your own professional standards and codes) – fools! However, if we ignore these posts or, worse still ‘like’ them are we not similarly guilty by association? The Society of Radiographers (sorry again non-UK readers) has produced a new document on raising concerns about unprofessional behaviour2 and there is a clear statement that we have a professional duty to raise concerns about unprofessional behaviour. Sure, a radiographer offloading their frustrations after a bad day on a ‘closed’ website is small fry compared to the physical abuse or neglect of a patient but it still constitutes a breach of the standards.

So here’s my advice:

  • Remember NO site is truly closed so think carefully before you post anything but…
  • …don’t be put of using Social Media for building professional communities – they are a great source of support and networking
  • State clearly if you disapprove of any posts within a community in which you are a member, this offers guidance to the author who may be unaware of these issues as well as protecting yourself
  • And my favourite recommendation – radical now…consider an ‘open’ site where members of the public (yes patients!) can also join in the conversation. Engage them in thought-provoking conversations; find out from them why the feel so disorientated that they put their feet on the pillow, instead of sniggering about it behind their backs. Social Media used this way becomes a powerful tool to help understand the patients’ perspective, share ideas with them and provide a more patient-centred service.

Practitioner/Patient Teamwork

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.

Teamwork

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!

 Frudatration

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

Time to change?

6cs

One of the 6 ‘C’s is Courage. This refers to practitioners being prepared to raise their heads above the parapet to identify when things are less than satisfactory for patients, and to suggest a different way of doing things.
In our guest blog this week, WOMMeN practitioner member, Bev Hilton, mammographer at the East Lancs Breast Screening unit displays such courage. Here she calls for a more tolerant approach to patients who are late.

late
Late. When is late too late? When is a situation irredeemable? Can I get away with it this time?

These questions will be familiar to you if you’ve ever been late for a date, late for a meeting, or late for an appointment – and the majority of us will have been late for something, somewhere, sometime. But it’s what happens when you finally reach your destination that will make the occasion memorable; and whether it’s a bad or good memory.

If you’re late for a healthcare appointment, it’s likely that your stress levels are increased to start with – ‘white coat syndrome’ doesn’t improve anyone’s day. Then there’s the likelihood that you’re feeling under the weather or just damn dreadful; pretty likely if you’re using healthcare services. How about depression? A lot of people are depressed these days, almost one-fifth of the adult population, and that makes getting out of bed difficult, never mind getting somewhere to a strict time limit. And then we have plain old bad luck. The traffic jam, the unexpected childcare rearrangement, the lost car keys and the entire universe conspiring against you – admit it, you’re STRESSED.

So, you get there but you’re late. And then it goes one of a few ways: the receptionist greets you, reassures you that you can be seen, although there may be a small wait. Or, that you’ve missed your appointment and can’t be seen. Or, that you can be seen, but will have to wait till the end of the clinic. Alternatively, the receptionist greets you, reminds you that you are late, and says that they’ll check if you can be seen, returning to say that it was a close call, but the doctor/nurse agreed that you can be seen after waiting to see if another patient misses an appointment.

All but the first one is likely to get the blood fizzing, isn’t it? And it can be the way it’s said sometimes – some people just have no idea how to talk to other adults without sounding condescending. Ooh, it can really be infuriating!
What happens next? Well, I’m guessing a response ranging from mild irritation to full blown rage – it’s not as if you MEANT to be late! Where do we go from here? Sometimes, an argument ensues, upsetting both to you and to the receptionist; or just a short, abrupt nasty exchange – still upsetting to all concerned. Other times, you stay silent, appearing aloof and uncaring: there’s nothing you feel that you can say. In all these scenarios you feel powerless and hurt; you won’t be coming back here in a hurry to be treated like this.

How do we improve on this? I think that we improve by remembering the humanity of it all.

courage

I think that in the rush to provide an efficient, time-pressured service, it’s easy for the staff to forget that everyone has a story. Progressive, modern Great Britain is still obsessed with manners, etiquette, class and rudeness – it’s long been held that to be late is to be rude; the old adage being that to be late is to assume that your time is more important than theirs, but that’s just not the whole story at all. A progressive, modern, healthcare provider isn’t there to judge; it’s to make sure that people get the healthcare they need: inclusive is the word we’re looking for here.

The section of society that needs the services the most are often the most vulnerable, and thus more likely to be late or to miss appointments, but to deny access to the services because of an ‘infringement of the etiquette rules’ is far from helpful, and could in the long run impact on people’s health in a major way. This is counterproductive from a healthcare provider’s point of view: that section of society ends up costing even more. If we look at the issue of missed appointments in breast screening, we’re looking at a missed opportunity to find that breast cancer at the earliest prospect.

Now, I can see that from the healthcare providers’ perspective, that when they’re delivering clinics to meet an endless demand, late or missed appointments cause significant disruption to the service, increase costs, and cause waiting times to increase. When we’re talking about breast screening, where the provider is attempting to invite everyone eligible for their mammos within a three yearly interval and accountable to several government bodies to do so, well, we can see that the pressure is on.

The mammographers and everyone staffing the breast screening service work hard within a time limit of six minutes per appointment to provide a high quality service, and all with a smile – but that sometimes doesn’t happen does it? I realize that most staff are pleasant and eager to help in the face of sometimes intolerable abuse, but I can never agree with turning people away from a health appointment just because they are late for it. There’s always six minutes in the day somewhere where someone can be squeezed in. I don’t agree with ‘politely’ reminding someone that they are late either – what’s the point, other than to make them feel bad? What is being achieved here, other than the satisfaction of seeing someone beg for forgiveness – and that’s not what anyone needs if they have struggled against several untold factors already just to get there. The likelihood of someone to return to use the health service diminishes with each time this happens; and the likelihood of staff facing an irritable client increases each time such passive aggressive tactics are used.

Healthcare staff, ironically, don’t often use the services they provide in the same way as the ‘(wo)man on the street’ as they are more likely to know ‘the system’; neither are they part of the vulnerable echelon of society, so it’s possible that the understanding of what it feels like to be powerless in the face of the big machine that is the NHS just isn’t there. It’s a deeper empathy that’s required, and one that can be difficult to grasp if you haven’t any experience of it.

Communication and conflict resolution skills are continually taught in the NHS – and they should be. It’s one of the most important skills required to make people feel valued and maintain a person’s dignity and co-operation – especially when delivering a well woman breast screening service.

So, I’m asking the staff, next time someone turns up late – let’s consider the whole story. They might have faced several health issues and sheer bad luck and timing just to get all the way across town for this; let’s respect the effort it took.

Social Media to enrich radiographic practice: are we green for go?

Main_page_of_The_Social_MEDia_Course

I’ve been busy tweeting about ‘SoMe’ (social media for the uninitiated) guidelines this weekend, eliciting thoughts and suggestions for the development of a radiography-specific set of principles to facilitate the use of SoMe in professional practice. So this blog is not concerned with the ‘hazards’ of private SoMe networking but with the application of Twitter, Facebook, Linkedin, Pinterest and/or other platforms to carry out our professional business.

Before summarising what the twitter community shared let me explain why I think radiographers should/could be using SoMe to enrich their practice and what it is that is different about communicating on SoMe that means it’s important to have some explicit reference to SoMe within our codes of professional conduct.

First, there’s professional networking for CPD, educational and development. Although a recent systematic review into the use of SoMe for professional development conducted by Lawson & Cowling (2015) found no examples from the radiography profession (they had to look to other professional groups for evidence) very recently the excellent journal club medradjclub has emerged as an opportunity for radiographers around the world to share ideas and educate one another. The Facebook group, “I’m Not A Nurse…I’m A RADIOGRAPHER!” also exists. This less formal (and more private) networking space for radiographers is a mixture of social chat but also professional information sharing.

The literature is more fruitful in terms of SoMe in formal educational contexts. For example see Alexandra Partner’s article on the Society of Radiographers news web page in 2013 ‘Social Media for Learning and Teaching – Beyond Facebook’ . I also have undergraduate students using Whatsapp to support their Problem Based Learning and these students will be presenting their experiences at UKRC this year.

However, SoMe offers us a much more exciting opportunity to engage with the wider world; not just radiographers and other health professionals but patients and service-users. This has traditionally been tricky for diagnostic radiographers, because we just don’t have the luxury of time to be able to develop a therapeutic relationship with our patients. Consequently, our communication is often rushed and too late to be truly effective. Think about it, our patients want to know what to expect before they get to us. This need has traditionally been met with leaflets and nowadays on-line videos. But these sources are unidirectional; what if patients still have questions or they don’t understand this information? SoMe gives us the opportunity finally, to engage with patients before the examination using a two-way process. If we invested some time in re-thinking our working practices SoMe could be use to dramatically change the patient and radiographer interaction.

If you need some convincing here is an example of a Facebook exchange between some women on our WOMMeN (Word of Mouth Mammogram e Network). WOMMeN is a project which brings clients of the NHS Breast Screening Service together with mammographers to discuss experiences of breast screening. The aim is to allow the woman to ask questions, share her experiences and feel she is being heard. Out of this comes a mutual understanding (between practitioner and client) of what needs to take place. Discussions are shared on the site so other women can join in and support one another too. Names in the extract have been changed for anonymity and some editing for brevity’s sake, however the discussion can be read on the open page.

Pat: Personally found it unbelievably painful and I felt quite traumatised after the procedure. It did beg the question around the risks of having the most delicate tissue in the body squashed between two plastic plates, as hard as possible? There must be a less painful, less traumatic way of breast screening….. Or is it just me that thinks this?
[others respond, feeling the same]

Pat: Phew it’s good to know I’m not alone…. Thanks M and A!

Angie (Mammographer): I am sorry to hear that you had a terrible experience, but please don’t let it put you off! As a mammographer it is upsetting to us when ladies find it so uncomfortable, but there is a fine line between a good diagnostic mammogram and an inadequate one. It would be awful if you were to be recalled and have to go through it again due to insufficient compression or blurring. Sometimes it might be due to the time of month, the way the breast was positioned or that you genuinely have very sensitive breasts. Please ensure to let the mammographer know next time you go about your previous bad experience so that may, hopefully, try it make it easier. As an aside, try to avoid caffeine or cigarettes before you go and take an analgesic! Give anything a go

Pat: That sounds like really good advice, Angie! Thankyou!

Mandy: I believe it’s a very personal and subjective experience for all of us F. and it’s really good that we’re talking about it!

Pat: Preparation and education would be really helpful…. A friendly welcome and full explanation not just a leaflet… Sometimes the Nhs forget we are people who feel and not just numbers and statistics ….. Care and compassion…. It really does help !!!

Andy: Well said P. Facebook at its best, informing and allowing an inclusive debate.
(Incidentally, we have ethics approval and patient consent to use the WOMMeN posts– supported by an excellent guideline from INVOLVE on the ways in which different types of social media are being used to involve the public in research)

So here is a great example of how SoMe is working to bring practitioners and clients/patients to a better mutual understanding. Furthermore, the demonstration of compassion and professional knowledge in this way can only raise the profile of the radiographer in the long term too. However, do the current guidelines on the use of SoMe encourage this innovative approach? Let’s return to what Twitter turned up this weekend.

Some tweeters felt there was sufficient guidance already provided in current documents such as the Radiographer’s Code of Professional Conduct (2013). Section 1 on Relationships with Patients and Carers would indeed appear to support WOMMeN’s aim to: empower patients to make decisions about their care, ensuring they have appropriate information to provide informed consent and being sensitive to the needs of vulnerable groups and those with culturally diverse needs. Making the most of on-line opportunities to have conversations with patients fulfills all these requirements. However, it also states “the use of social media such as Facebook™ or Twitter™ to publicise thoughts, actions and feelings can increase the risk of breaking patient confidentiality. You need to take extra care and act with absolute discretion at all times”. So whilst the Code does not prohibit the use of SoMe it misses a trick by failing to identify the opportunities afforded by SoMe for fulfilling the other requirements within the code.

Such encouragement is something which is evident in the Royal College of General Practitioners’ Social Media Highway Code however. Number 10 of their 10-step code is “Test out innovative ideas, learn from mistakes – and have fun!” This useful code therefore supports the vision to utilise SoMe to enrich practice.

Another tweeter provided a useful link to the SCoR. “Social media guidance for SCoR groups”. https://www.sor.org/about-radiography/media-centre/social-media-guidance-groups (You may not be able to see these unless you’re a member of the SCoR and logged in). So here are some specific SCoR guidelines on SoMe which is great however it turns out these are only aimed at SCoR groups not individuals. Furthermore, they are written in a  prohibitive rather than enabling style. E.g.

You must ensure accounts using SCoR names/branding or affiliated with the SCoR do not bring the SCoR into disrepute (for example, by aggressively criticising or entering into personal arguments with individuals and/or organisations, making defamatory comments, posting or providing links to inappropriate content). (Quick aside – “whilst I’m a member of the SCoR Radiographic Informaticss group these are my own words and I am not representing the group in this blog!”)

You must not breach copyright (for example by using other people’s images/words without permission. Please note that using images found on Google can also breach copyright).

You must not post offensive or derogatory comments (including but not limited to posts about sex, gender reassignment, race, nationality, sexual orientation, age, disability, religion or belief).

The same guidance also says, “Please check your employer’s policies on social media and IT use, to ensure you are not in breach of any of their rules (especially about personal use/social media use during working hours)”. There are a couple of issues here. Firstly, this suggests that using Social Media in hours is problematic, which would not support the notion of radiographers embedding on-line patient communication as part of their daily working practice. Secondly, referring to local policies leads to non-uniform practice. For instance, the mammographers in the WOMMeN group found a range of guidance within the North West region which may result in them engaging differentially with the project.

Another Tweeter forwarded a useful link to NHS Employers Social Media Guidelines This links to guidelines from 10 professional bodies but excludes radiographers. However there is a link to the HCPC guidelines: “Focus on Standards: Social Networking Sites”. These include the statement,

“When you post information on social networking sites, think about whether it is appropriate to share that information. If the information is confidential and is about your service user, patient, client or colleague you should not put it on a site. This could include information about their personal life, health or circumstances”.

Again, this could discourage radiographers engaging in discussion with patient or clients since part of that discussion may result in patients sharing concerns and therefore disclosing personal information, albeit willingly.

So where does all this leave us? There are definitely codes of conduct which tell us how to communicate with those in our care, and the SCoR and HCPC have taken great care to protect radiographers in this regard. These codes also allude to social media. However, for the most part the tone is set so as to restrict practice rather than liberate it. In this brave new world there are amazing opportunities to change how we engage with others and present ourselves to the outside world. At the moment though, the standards, codes and guidelines do not go far enough to encourage us to take advantage of SoMe as a force for good. The exception to this is the RCGP Social Media Highway Code. We could adopt these easily for our profession but they do need to be adapted rather than adopted to ensure they capture the unique ‘relationship’ radiographers could have with their patients as facilitators of information and, in some instances, promoters of public health.

laptop and stethoscope

Embarrassed?

Julie Stein Hodgins who is a Baby Feeding Specialist, Breast Screening Mammographer and member of the WOMMeN project considers how mixed cultural messages are responsible for such diversity around our conceptualisation of the breast, and how this influences breast awareness and self-examination.

Women have mixed views about breast screening and about social media. Combine these two things and we have an amazing array of perceptions, attitudes and beliefs that take some unraveling. Our WOMMeN project is getting to grips with these things. One clear message though is that women’s perceptions of their breasts are wide-ranging and one size does not fit all – if you’ll excuse the pun!
A number of women in our study reported shock at the depersonalisation or disembodiment of their breast during the mammographic examination. This was perceived both in terms manual handling of the breast by the mammographer and the pancake-like disembodiment of her flesh.

A number of women in our study reported how uncomfortable it was to have their breast handled by another person during a mammogram, or breast X-ray. Often women have heard that the breasts are squashed like a pancake! Sure they are handled by a female Practitioner and then squashed, but not as thin as a pancake.

Manual handling and compression is necessary for technical reasons based on a need to ensure the best, quality image is taken so that an accurate result is received by the woman. When other parts of the body are x-rayed, people tend not to mind, but the breast is different. Its purpose is ambiguous, vague, and means different things to different people. For some women the breast strikes at the very essence of who she is, representing both her sexuality and femininity. One woman told us that no-one had ever touched her breasts before except for her husband and she was deeply shocked at this experience. For other women, the breast fulfills a functional role.

What stops some women, of any age, checking what is normal for her breasts each month? Is it embarrassment? Most of us can cope with the commercialism and sexualisation that we pick up from the society around us, others might be influenced in a non constructive way. Some feel that they are embarrassed about their breasts….where does that come from?…maybe it is the multitude of mixed messages that we receive about breasts from very early on in our lives.

With the best will in the world, most of us are not aware that we have been subjected to mixed messages about our breasts all though our lives. Pick up a child’s story book and see how often animals are used in stories with baby animals being bottle fed by their parents, very little human breastfeeding images. Should we breastfeed a baby…in public or confined to the home…or does it matter…I see more breast tissue on a Saturday night in my local town. Do you?
Buy a car magazine for your car mad young son and try removing the semi naked women’s pictures before you give it to him.

Why do boxers have full breasted women escort them to the stage? Images of breasts are everywhere.

Breasts are all about selling in these examples.Then there are TV programmes scaring us more, but they have to entertain us, make money and get us to watch more programmes. Businesses make money from doing breast enlargements; sure some women benefit from this operation, do you know someone who has but forgot they may have to replace them in a number of years? It is sad for me when a woman tells me that their ‘boyfriend/husband bought the implants as a present’.

So why am I writing all this? We should all be breast aware; what does that mean? Check yours or your partner’s every month, if it is different from last month, go to a doctor. Often lumps can be cysts so find out.

Can your breasts kill you? Well you can get a disease that is called cancer. There are many different types of breast cancer; usually most of the cancer types can be treated especially when detected early. Newspaper articles and websites say many things about breast screening: is it good, is it bad for you? How do you know? Some say we don’t need an operation at all but the trouble is they often are not clear about how to find out which type of breast cancer you might have. Most of us do not have and never will get breast cancer, but for our friends who do let’s get them quality advice and diagnoses, then they are more empowered to make their own choices.

In the safety of your our home you can check your breasts in front of a large mirror, for a written description visit http://www.breastcancercare.org.uk/breast-cancer-information/breast-awareness/being-breast-aware/changes-look-feel

or watch Breakthrough Breast Cancer’s video

Sure if you have very large breasts it can be embarrassing, but you are in your own home. Did you know? Some women are embarrassed if they think they have small breasts, other breasts have gone south and sideways, and yes, some even have ‘page 3’ style.

Whatever your size, shape and perception of breasts, don’t be afraid to give them the regular attention they deserve.

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