Patient satisfaction is more important than ever—but is quality at stake?

The introduction of curved mammography paddles to the medical market in 2017 was explosive—the new paddles, designed to ease women’s breast pain during the exam, were soon the subject of CNBC interviews and Shape magazine articles. Manufacturers have claimed the curved paddles “deliver a more comfortable mammogram without compromising image quality, workflow or dose,” but a pair of Colorado-based clinicians are questioning that.

“Although the patient experience is clearly an important concern, it should be recognized that adopting this approach may place the quality of the care at risk,” authors Rebecca M. Marsh, PhD, and Michael S. Silosky, MS, wrote in the Journal of the American College of Radiology. “A recent experience in mammography has highlighted the value of continued diligence to maintain image quality and safety in a field where services are increasingly guided by gaining more ‘likes’ for the facility.”

It might be easy for radiologists to dismiss the glitzy ad campaigns surrounding curved paddles, Marsh and Silosky said, but mammograms are a routine part of a woman’s health upkeep—and patients care about them. Thirty-seven percent of women reported in one survey that a painful mammogram would cause them to leave a dissatisfied patient review; in another survey, 49 percent said they’d change mammography providers in favor of a facility that provides more comfortable mammograms.

And although patient satisfaction surveys seem trivial in the exam room, Marsh and Silosky wrote they’re key in determining a facility’s federal reimbursement for healthcare services, “incentivizing providers, facilities and vendors to focus their quality improvement efforts on improving survey scores.”

Initially, the authors were no exception—the colleagues’ practice recently received a new mammography system with the addition of a curved paddle. Initial testing using flat field and lipid-gel phantoms yielded imperfect results, including significant nonuniformities and artifacts on the images. When the testing team moved forward and applied the curved paddle to a singular patient exam, the same artifact appeared on the screen. The rest of the woman’s exam had to be completed using a standard, flat paddle.

The facility contacted the paddle’s manufacturer, who reiterated that the curved paddle offered equivalent image quality to standard paddles while increasing comfort levels. The issue was never resolved, and Marsh and Silosky’s practice had to revert to using flat paddles in the clinical setting.

“Although popular media and vendor marketing may have a significant effect on patient expectations, the radiology community cannot allow the importance of patient satisfaction survey scores to supersede image quality or safety,” the authors wrote.

They also pointed out their case can be applied not only to mammography, but other medical practices. For instance, buzz surrounding Dr. Oz—who Marsh and Silosky refer to as the “surgeon-who-shall-not-be-named”—resulted in the dissemination of advice that went against the guidelines of major groups like the Society of Breast Imaging and American College of Radiology.

A better balance could be achieved in the future by implementing equipment testing teams in hospitals, shifting the focus of healthcare professionals from diagnostic interpretation to maintaining safe, effective practices and addressing patient concerns head-on, the authors said.

“The purpose of diagnostic imaging is to produce images that can determine the presence of and characterize disease,” they wrote. “Although maintaining patient satisfaction is important, it is incumbent upon the radiology community to ensure that this does not come at the cost of compromising image quality and patient safety.”