In my role as a radiography lecturer, I have to say I come across the most inspiring and amazing radiographers. Some of these are highly experienced practitioners who volunteer to lecture to students, others are involved in our research; the mammographers who work with me on the WOMMeN project are a fine example of this. They all give of their time freely to push forward the boundaries of the profession.
We also churn out some fabulous graduates, from both our BSc and Masters programmes. Only last week, 17 radiographers were given the University of Salford’s stamp of approval to be able to perform barium swallows. At the end of next term we expect a further 80 or so radiographers to graduate with skills as diverse as ultrasound, mammography, reporting (in a range of specialist fields), breast interventional procedures, cardiac stress testing, and CTC. In short, the profession is awash with practitioners who have enhanced skills and knowledge and have extended their role to meet service demands. Having just received this month’s Radiotherapy and Imaging Practice I see there’s a big push for independent radiographer prescribing. The point is this: radiographers are dynamic and flexible. They are not afraid to meet the challenges of role extension.
I was therefore perplexed to come across a research article published in the Summer 2009 Allied Health Journal. This research showed that in comparison to five other allied health professions (physios, OTs, podiatrists, SLTs and dieticians) in Scotland, radiographers exhibited significantly less transformative leadership behaviours such as power, confidence and ideals. The research involved self-reported questionnaires, suggesting it is radiographers themselves who admit to not engaging in transformative practice, in other words practice which is critical and attempts to challenge or change the status quo.
I thought about this, and about the enthusiastic and motivated students who graduate from our programmes and wondered why. The report’s authors suggest that because radiographers use ionizing radiation their working practices are very prescribed; working outside protocols in hazardous environments like ours may be considered irresponsible, and this has bred a culture of compliance with rules. Could this really be why radiographers, whilst supremely competent and confident as technicians, are trailing behind as leaders of change?
Then I had another fascinating conversation with a reporting radiographer. One of those keen professionals described above who has continued to learn and develop throughout her professional career she is now about to start doctoral level study. She relayed a very thought-provoking anecdote which may also speak to the heart of the problem.
She had just x-rayed a patient and, upon viewing the images could clearly see there was an abnormality. When asked by the patient whether anything was wrong, however, she was unable to discuss the images and diagnosis with her. Despite the College of Radiographers guidance on honesty and transparency with patients when it comes to disclosing information, custom and practice has resulted in a culture of fear which discourages radiographers from engaging in diagnostic conversations with patients. Such practice is, again, often embedded within local policy, or at least many radiographers will tell you this is the case.
The story doesn’t end here though. The patient was returned to A&E to get her diagnosis from another professional, an Advanced Nurse Practitioner, who was not too sure whether there was an abnormality on the image. The ANP called the radiographer round to A&E to point out the abnormality. The patient was in attendance, so as a result the radiographer who was previously unable to talk to the patient about her diagnosis, was thus given ‘permission’ to now discuss the image in the presence of the patient, by another health practitioner.
So there is a fundamental problem here. We have historically hidden from view and deliberately avoided conversations with patients, leaving others to convey the messages embedded within our images. The world is changing however. Patients are beginning to take a central role in decision-making which means they have to be helped to understand the information in their records, including image data.
Our reluctance as a profession to get involved in such conversations means that others will instead be doing it for us, and in the process we are at risk of becoming even more invisible, not only to other professionals but to patients too.
Another virtual conversation (on our group’s Whatsapp chat) I overheard recently between students went like this:
Trying to explain radiography to people from other countries: frustrating!
“So a nurse technician?”
“So like a technical assistant?”
“So a doctor”
But then you explain the extent of the role and it’s like “how can someone who isn’t a doctor do that?”
So, there we have it. Despite the fact that many radiographers as individuals are some of the most technically adept health professionals I have come across, ready to embrace new areas of practice and push the boundaries of role extension, we’re still pretty much invisible to the outside world.
In writing this I have struggled in a chicken and egg kind of way to understand which came first; conformist work practices or lack of presence. Either way, it’s time to find our voice as a profession and shout about the fantastic things we are capable of. If we don’t we’ll remain forever hidden to the outside world by our lead-lined barriers. Radiographers : “DO NOT ENTER”.