Radiology

Specializing in all the modalities of on-site and remote radiologic coverage, plus after-hours final reads, we deliver prompt, accurate preliminary and final reads interpretations.

Sheridan’s industry-leading quality management program ensures that our discrepancy rates are consistently well below the national average. Radiology turnaround routinely transcends contracted times and 24/7 coverage is available. Sheridan radiologists are always available for additional consultation.

The stability of our clinical staff is evidenced by a 95% retention rate. All physicians are fellowship-trained or board-certified, locally licensed and based in the United States. We follow NCQA certification for credentialing and conduct our own approved physician review process. Learn more about our radiology management services.

Read our radiology-related posts:

29 November2016

Three Radiology Research Projects to Better Understand Concussions

A recent article in Radiology Today illustrates how radiological imaging is becoming an increasingly important tool in studying and diagnosing concussions.

The Centers for Disease Control and Prevention estimate that 248,000 children and teens visit the emergency department each year to evaluate concussions suffered during physical activity. Concussions, also known as mild traumatic brain injuries, have serious short- and long- term effects on thinking, sensation, language and emotion. In the short run, repeated concussions can potentially cause dramatic, fatal brain swelling. In the long run, they have increasingly been linked to Chronic Traumatic Encephalopathy (CTE), Alzheimer’s, Parkinson’s disease and other brain disorders.

Public awareness of the alarming short- and long-term effects of concussions is growing quickly, but timely diagnosis remains difficult. Most diagnostic methods for concussions – particularly on athletic fields – are dependent on evaluation of symptoms that are often understated by athletes. Although radiological imaging is not yet a practical sideline solution, researchers have used it to better understand the physiological effects of concussions and track the brain’s recovery. The September 2016 issue of Radiology Today presented three current projects demonstrating how researchers are using imaging to better diagnose concussions, understand their severity and determine how they impact athletes’ brains. 

  • MRI Blood Flow Examination – Researchers at the Medical College of Wisconsin presented a study at the American Academy of Neurology’s Sports Concussion Conference in July on cerebral blood flow in football players. The study found that while concussed players’ symptoms would often improve to baseline levels by the eighth day following the injury, MRIs indicated ongoing low blood flow after the same amount of time. Decreased blood flow is often used as an indicator of cerebral microbleeds. Microbleeds are most commonly found in people over 60, and should not be present in high school students. Youth athletes demonstrating signs of microbleeds could potentially be at risk for CTE, which is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression and progressive dementia, according to Boston University’s CTE Center.  
  • Combining TechniquesResearchers at the University of Texas Southwestern Medical Center, Wake Forest School of Medicine and Children’s National Medical Center published a study in the May Journal of Neurotrauma finding that a single season of football can result in brain changes. The techniques they used include:
  1. Equipping helmets with sensors that detect impacts players received.
  2. MRI diffusion kurtosis imaging that detects both normal development and pathological changes in the white matter that allows the brain to make proper neurological connections.
  3. PET scans to detect tau proteins that are believed to cause cognitive impairment in Alzheimer’s patients.

The researchers are next looking to conduct longitudinal studies to observe long-term brain development. They are also planning to study non-helmeted athletes through alternative techniques such as equipping mouth guards with sensors.

  • Ultrasound Examination – In May, the American Association of Neurology presented a study that used ultrasound to map changes in blood flow after an injury. Although traditional ultrasound could only differentiate between concussed and control groups 60 percent of the time, the advanced software improved diagnostic accuracy to 83 percent. 

How Sheridan Healthcare, Jupiter Medical Center and Joe Namath Developed a Groundbreaking Treatment Protocol for Traumatic Brain Injuries

In 2014, Sheridan began a partnership with Jupiter Medical Center and legendary Jets quarterback Joe Namath to study the effectiveness of hyperbaric oxygen therapy to treat traumatic brain injuries. The FDA-approved clinical trial led by co-directors of the Joe Namath Neurological Research Center, Barry Miskin, MD, FACS and Sheridan Healthcare Radiology Medical Director Lee A. Fox, MD, MA, investigates how breathing pure oxygen in a pressurized chamber can stimulate the growth of new blood vessels to help the brain recover. After seeing improvements in Namath’s cognition and memory as a result of his continued hyperbaric oxygen therapy, the team hopes the study will provide valuable insights into how to combat the degenerating effects of concussions. While research and development of treatment options for concussions are in their early stages, the future applications could literally be game-changing.

For more information, see our blog post on hyperbaric oxygen therapy research.

17 November2016

Career Advice from Sheridan’s Chief Medical Officer for Radiology Services

One of the best ways to achieve success is to emulate and seek advice from someone who already has achieved that success. Frank Seidelmann, DO, one of this country’s foremost radiology experts, serves as an excellent role model for anyone looking to become a successful leader in radiology. Dr. Seidelmann is Chief Medical Officer and National Medical Director for Sheridan’s Radiology Services, the largest hospital-based radiology practice in the United States and the only unified, national standards-based radiology service provider. He recently was honored with Sheridan’s 2016 Leadership Award. 

In a recent article in Radiology Life, Dr. Seidelmann shared his path to the top of his profession and offered career advice on attaining a radiology leadership position.

Be Proactive in Managing Your Career

He advises those who aspire to follow in his footsteps to be proactive and forward-thinking in managing their careers. Thriving in a field that is constantly changing and facing widespread, fundamental disruption requires “developing expertise in areas that interest you and that you believe will be important.”

Dr. Seidelmann started down that path during his 1972-1976 residency at the Cleveland Clinic, where he was the chief resident in radiology and president of the house staff. Cleveland Clinic owned one of the first head CT scanners and the first whole body CT scanner and he was one of the first radiologists to work with cross-sectional imaging. Early in his career he chose to practice and develop expertise in several of the first radiology subspecialties that evolved from these new imaging technologies, before eventually narrowing his focus to MRI imaging interpretations.  

Embrace Technology

Dr. Seidelmann urges would-be radiology leaders to constantly stay abreast of emerging trends and technologies and to look for opportunities to solve problems with creative, technology-enabled solutions – something he has done throughout his career.

Dr. Seidelmann had co-founded what became a large, multi-state, multi-hospital radiology group with its own MRI imaging center. Seeing an opportunity when that practice was sold, he co-founded a software company whose product helps imaging centers understand their referral patterns, volumes and trends.

He was a pioneer in distributed teleradiology. In 2001, two years after launching his first teleradiology practice, he and a colleague merged their practices to bring to life their visionary concept: finding the best subspecialty radiologists in the country and connecting them in a distributed practice with teleradiology services. The new practice grew rapidly and in 2007 became a full-service radiology group, Radisphere National Radiology. Dr. Seidelmann also designed a QA process that was embedded into the company’s enterprise software system to enable real-time, daily QA assessment of cases. The software, analytics and business processes were so valuable that they eventually were split off from the professional services and launched as an independent software company. Sheridan acquired Radisphere last year.

Invest in Your Own Development and That of the Physicians You Lead

Dr. Seidelmann also advises those pursuing a leadership role in radiology to invest time and effort not only into the development of the physicians under their leadership but also into their own professional development. Despite his lifetime certification, Dr. Seidelmann has recertified multiple times over the course of his career to maintain and expand his skills and expertise.

Learn much more about his remarkable career and helpful career advice in his Radiology Life article, “How-To Guide: Becoming the Chief Medical Officer of a Radiology Practice.”

15 November2016

Radiology Subspecialization Is Creating New Challenges

Advances in medical imaging technology in the past several decades have transformed the practice of radiology. The simple X-rays of the past have largely been replaced by digital images of astounding quality and 3D imaging. But being able to interpret the much more detailed information to make better diagnoses requires highly specialized diagnostic expertise, and the increasing subspecialization of the radiology field is creating new challenges.

Better Image Quality Requires a High Degree of Specialization

In a recent Radiology Life article on “The Radiologist’s Role in Improving Diagnoses,” Frank Seidelmann, DO, Sheridan’s chief medical officer for radiology services, said “there is absolutely no area of the body that cannot be explicitly imaged with the tremendous diagnostic tools we have.” In fact, those images are so good that currently radiology is broken out into three different disciplines spanning 13 areas of subspecialty: diagnostic radiology, including six subspecialties; interventional radiology/diagnostic radiology, including five subspecialties; and radiation oncology, including two subspecialties. 

Clearly it isn’t possible for individual radiologists to develop expertise in all these areas. But since most radiology groups comprise 10 or fewer radiologists, radiologists are increasingly required to interpret studies outside their areas of expertise. And Dr. Seidelmann explained that even though larger radiology groups may have expertise in a wider range of subspecialties, they still face the challenge of insufficient clinical information. 

Insufficient Clinical Information Hampers More Accurate Diagnoses

Sheridan’s chief of teleradiology, Glenn Kaplan, M.D., agrees, saying the biggest challenge radiologists face is that referring physicians rarely give them all the relevant patient information they need to make their readings more accurate. In his article “Technology Innovations That Will Transform Radiology and Patient Care” in Healthcare Tech Outlook, he said the most common “reason for exam” listed on the order sheet is simply “pain,” adding that lack of interoperability of EMR systems often prevents radiologists from accessing the patient’s medical history themselves.

The volume and negative impact of diagnostic errors is a significant problem. According to the 2015 report “Improving Diagnosis in Health Care” by the National Academy of Medicine, 5 percent of U.S. adults who seek outpatient care each year experience a diagnostic error. The report also found that diagnostic errors contribute to approximately 10 percent of patient deaths and account for 6 to 17 percent of hospital adverse events. 

Dr. Seidelmann called fixing this problem “a moral imperative” and stressed the need for greater collaboration between referring physicians, patients and radiologists to improve diagnostic accuracy.

Technology also will play a big part in solving this problem in the future. The Watson Medical Imaging Collaborative, of which Sheridan is a founding member, is leveraging IBM Watson’s highly advanced cognitive imaging and computing capabilities, and their work promises to give radiologists unprecedented diagnostic support, enabling them to provide much more accurate readings and significantly reducing the number of human diagnostic errors. The potential benefits to patients are significant: Dr. Kaplan estimates that reducing U.S. radiologist errors by just 1 percent could save or improve the lives of thousands of patients per year.  

8 November2016

Wilhelm Roentgen’s Legacy and the Future of Radiology

​November 8, 2016 marks the 121st anniversary of the discovery of X-rays by Wilhelm Roentgen. Today Sheridan pays homage to Roentgen and the others whose discoveries have contributed to the evolution of radiology and expresses its appreciation to the hospitals, equipment manufacturers, radiologists, and radiology technologists and technicians who have developed and advanced the science and art of medical imaging. 

Key Milestones in Radiology

X-rays

The year after Roentgen’s discovery brought the first handheld fluoroscopic device (by Thomas Edison) and the first diagnostic radiograph in the U.S. Plain X-rays, most often used to determine the type and extent of fractures, remain the most commonly used form of imaging, per the International Society for the History of Radiology

Ultrasound

Ultrasound, whose widespread clinical use began in the 1950s and ‘60s, is the second most commonly used form of imaging exam. Some of its uses include echocardiography, checking the development of the fetus in pregnant women, guiding needle placement when injecting local anesthetics near nerves and assessing gallbladder abnormalities. Modern scanners’ Doppler capabilities enable duplex ultrasound for diagnosing arterial and venal disease, and continuous wave Doppler ultrasound that can be used at the patient’s hospital or ICU bedside for patients who are too ill to be moved safely to the radiology suite. 

Nuclear Medicine and Molecular Imaging

The concept of emission and transmission tomography, introduced in the late 1950s, plays an essential role in many medical specialties including cardiology, oncology, neurology and psychiatry. Molecular imaging uses biomarkers to help image specific targets or pathways and interact chemically with their surroundings, changing the image according to molecular changes occurring within the target area.

Positron emission tomography (PET) imaging includes FDG-PET that can, for example, detect differences between cancer and normal cells by their glucose consumption, and single photon emission computed tomography (SPECT) that is used extensively to study cardiac health and blood flow to the brain.

Magnetic Resonance Imaging (MRI) became a clinical tool in the 1980s and is arguably the most flexible diagnostic imaging modality, allowing radiologists to view everything from a patient’s metabolism and physiology to his or her tissue microstructure. In the 2000s, 3T scanners came into widespread use. MRI scanners continue to become not only faster and more accurate but also smaller, allowing limbs to be scanned without subjecting patients to the noisy, claustrophobic confines of a full-body scanner. New diagnostic tools on the horizon include combined modalities and targeted media contrast. 

Computed Tomography

CT, developed in the late 1960s, has become another essential imaging tool. It can be used to look for a wide range of problems in various parts of the body, from cysts, abscesses or tumors to pulmonary embolism or aneurysm. A CT intravenous pyelogram (IVP) is often used to look at diseases of the urinary tract. CT is increasingly used for CT angiography and coronary calcium scoring as an alternative to more invasive and expensive interventional medicine.

Hybrid Imaging

Increasingly, medical imaging techniques are being integrated to provide a more complete picture (literally) of the anatomy and function of a patient’s organs and tissues. An example is PET/CT, a hybrid imaging technique that superimposes the location of abnormal metabolic activity from a PET scan over the detailed anatomic image from a CT scan. Prostate PET/CT scans can detect cancer earlier than either CT scans alone or MRI scans. TIME magazine named the PET/CT scanner the medical invention of the year in 2000. SPECT/CT scanners are also available, and PET/MRI is an emerging technology.

Interventional Radiology

IR is often called the surgery of the new millennium. Interventional radiologists use the most modern, least invasive techniques available to minimize patient risk and improve outcomes. An example is transarterial chemo embolization (TACE), the injection of chemo-eluting beads directly into a hepatocellular carcinoma to target just the tumor, sparing patients the many side effects of traditional whole-body chemotherapy. Today’s extremely high-quality imaging also allows interventional radiologists to catheterize nearly any blood vessel in the body and perform lifesaving procedures (e.g., abdominal aortic aneurysm stent) at much lower risk than using traditional surgical procedures. IR is an exciting and important development, especially as we move to a value-based care environment.

Investing in the Future of Radiology

Until a few years ago, U.S. hospitals routinely purchased newer, more advanced radiology equipment to stay competitive. That demand drove ongoing investment by companies like GE, Siemens and Tesla in developing increasingly advanced imaging equipment. Unfortunately, that could change. In 2013, regulators began reducing reimbursements for medical imaging. The goal was to discourage problems of misuse and overuse, but those decreases may have other, very serious consequences.

Radiology represents the largest portion of most hospitals’ outpatient revenue, which has been hit hard by those reimbursement cuts. Consequently, new investments in multimillion-dollar radiology equipment will offer a lower ROI. Imaging equipment is expensive, but unless those investments continue, radiology’s progress will stagnate. Hospitals must continue to invest in the infrastructure that supports radiologists – not only imaging equipment but also ongoing education for the subspecialization required by increasingly detailed and complex imaging information. We encourage hospitals to follow the lead of others who are also investing in the future of radiology, such as IBM and other organizations (including Sheridan Healthcare) who are tapping the power of IBM’s Watson supercomputer to transform radiology and patient care

20 October2016

Postmastectomy Radiotherapy’s Value for Patients with Early-Stage, Node-Positive Breast Cancer

The American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO) recently issued a joint clinical practice guideline update for physicians who are treating breast cancer patients who have undergone a mastectomy. The update provides additional considerations to help physicians to determine which patients might benefit from postmastectomy radiotherapy (PMRT) and focuses on the role of PMRT for contemporary patients with early-stage, node-positive breast cancer.

While PMRT is clearly indicated for patients with very high risk of local regional failure, its use is controversial for patients with earlier-stage breast cancer, especially when there are three or fewer positive nodes. The new update focuses on this key area of controversy, stating that there is strong evidence showing that PMRT reduces the risk of breast cancer recurrence, but also providing evidence-based recommendations for the use of PMRT in patients with tumors smaller than 5 cm (T1-2 tumors) and 1 to 3 positive lymph nodes, as well as in patients undergoing neoadjuvant systemic therapy (NAST) and patients with T1-2 tumors and a positive sentinel node biopsy.

The expert panel that developed the updated guideline included representatives from ASCO, ASTRO and SSO. They reviewed relevant literature published between January 2001 and July 2015, including a meta-analysis of 22 clinical trials published in 2014 that provided evidence that PMRT is highly effective at preventing local breast cancer recurrence.

The focused guideline update emphasized that both the absolute benefit of PMRT and the benefit-to-risk ratio can vary substantially from one patient to another, and that doctors should obtain multidisciplinary clinical input and carefully consider factors that could reduce the potential benefit and increase the likelihood of complications before recommending postmastectomy radiation therapy. The panel also concluded that patients must participate fully in the decision-making process, and that their values as to what constitutes sufficient benefit and how to weigh the risk of complications against that benefit in the context of the treating physicians’ best information regarding PMRT must be respected and incorporated into the final choice of treatment.

Stephen B. Edge, MD, co-chair of the expert panel, said “We still don’t have a single, validated formula that can determine who needs PMRT, but we hope that the research evidence summarized in this guideline update will help doctors and patients make more informed decisions.” 

For more detailed information, read “Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update” published in the ASCO’s, ASTRO’s and SSO’s journals, Journal of Clinical Oncology, Practical Radiation Oncology and Annals of Surgical Oncology

This approach reinforces current practices at Sheridan partner Memorial Cancer Institute (MCI) which, like most cancer facilities, faces the complex considerations in deciding whether to recommend PMRT for this subset of patients. Sheridan collaborates with MCI oncologists and surgeons as part of a multi-disciplinary discussion addressing the relative risks and benefits of PMRT for each patient. This team looks at the patient’s entire clinical picture before making a recommendation, and patients are always included in the decision-making process.

19 October2016

Sheridan’s 2016 Leadership Conference Recognizes Eight Outstanding Clinical Leaders

The annual three-day Sheridan Leadership Conference is Sheridan Leadership Academy’s flagship event. This year’s conference took place Sept. 30-Oct. 2 in Orlando, Florida and was attended by nearly 600 physician and allied health leaders. 

 

Strengthening the Core

President of Physician Services Robert Coward and CEO Chris Holden provided opening remarks and introduced this year’s conference theme, “Strengthening the Core,” which focused on the key attributes required to succeed as a Sheridan clinical leader. Throughout the conference, each service line held multiple breakout sessions to promote discussion and knowledge sharing of topics related to the conference theme.

New Leadership Academy Programs

This year’s conference also marked the expansion of the Leadership Academy’s programs, whose participants are nominated by their leaders. In addition to the Emerging Leaders Program that began in 2014, the Academy added two new programs this year, the Physician Chiefs Program and the Allied Health Chiefs Program. Each of the three leadership programs kicked off its first course at the conference.

The 2016 Sheridan Leadership Award Winners

One of the highlights of the conference was the awards dinner, which took place on Oct. 1. Eight outstanding Sheridan physicians were honored with 2016 Leadership Awards:

Dr. Mike Adkins, Anesthesia Services Chief of the Year

Michael Adkins has been with Valley Anesthesiology since 1994 – providing cardiac anesthesia services for 13 years, serving as medical director at an outpatient plastic surgery center, and currently is chairman of anesthesia at Banner University Medical Center-Phoenix.

He also has filled important administrative roles during his tenure, including scheduling coordinator, division manager, board member, and principal in the formation and launch of Valley’s Mobile Services Division.

He is a former board member of the Arizona Medical Association and is president-elect of the Arizona Society of Anesthesiologists. He earned his medical degree from the University of Minnesota-Minneapolis, did a surgical internship at the University of Illinois in Chicago and received training in cardiothoracic and neuroanesthesia at Stanford University.

 

Dr. Joseph Toscano, Emergency Medicine Chief of the Year

Dr. Toscano has been an attending emergency physician at San Ramon Regional Medical Center since 1999 and chief of the department since 2013.

He has extensive experience and expertise in the field. In the early 2000s, he was a partner and corporate medical director for Pinnacle Medical Group, which operated five urgent care clinics in California and Arizona. He lectures frequently at urgent care conferences and is on the board of directors of the Urgent Care Association of America. He has been medical director of San Ramon Regional’s occupational medicine clinic since 1999.

He graduated from Dartmouth College and earned his medical degree from the Duke University School of Medicine. He trained in internal medicine at the naval hospital in San Diego and began practicing emergency medicine during an operational tour of duty with the U.S. Navy in the early 1990s. He moved to California in 1994 and has been an EM physician there ever since.

Dr. Frank Seidelmann, Radiology Chief of the Year

Dr. Frank Seidelmann is co-founder, chairman, and visionary force driving the success of Radisphere. Dr. Seidelmann brings a wealth of experience in radiology with subspecialty expertise in MRI and neuroradiology. He has more than 25 years’ experience in interpreting MRI cases and functions as a consultant on difficult cases for radiologists and clinicians around the country. He has lectured on MRI, both nationally and internationally.

Before venturing into subspecialty teleradiology in 1996, Dr. Seidelmann co-founded a highly successful hospital and outpatient imaging center based radiology group with 20 contracts in the Midwest and central states, at one time employing more than 50 physicians, which was acquired by Med Partners and later became Team Health. He also has owned several diagnostic imaging centers in Ohio and co-founded RIS Logic, a leading radiology software company that targeted diagnostic imaging centers. RIS Logic was later acquired by Merge Healthcare in 2003. Additionally, he has held staff positions at the Cleveland Clinic Foundation and Case Western Reserve University, and has expertise in small joint imaging.

Dr. Mitchell Stern, Women’s and Children’s Chief of the Year

Mitchell Stern, MD joined what was then known as Neonatology Certified in 1987, immediately after completing his Neonatal Fellowship at Babies Hospital (Columbia Presbyterian Medical Center) in New York City. He did his residency, including a chief residency, at Brookdale Hospital Medical Center in Brooklyn, New York. He attended medical school at St. George’s University School of Medicine in Grenada, WI and attended college at Cornell University in Ithaca, New York. 

Dr. Stern joined the staff of Plantation General Hospital in 1987 and became a Director of the unit shortly after Neonatology Certified became a part of Sheridan Healthcare in 1996. Besides being the clinical and administrative leader of the PGH Level III NICU, Dr. Stern has also been the Principal Investigator in several multicentered research projects and has been involved with several committees at both the hospital and HCA Corporate Levels.

Dr. Adam Blomberg, Diamond Award Winner

Adam L. Blomberg, M.D. is the Chief of Anesthesiology for Memorial Regional Hospital in Hollywood, Florida., as well as the National Education Director for Sheridan Healthcare’s Anesthesia Division. He serves on the Anesthesia Quality Committee at Sheridan as the co-chair of the Clinical Education & Best Practice Subcommittee. He has held positions at Memorial on the Physician's Satisfaction Committee and the Multidisciplinary Peer Review Committee as well as the Co-Chair of the Surgical Services Executive Committee.

Dr. Blomberg has had numerous articles published on anesthesia trends and best practices in leading industry publications, such as the Wall Street Journal, CNN Health, ASA Newsletter, Anesthesia Patient Safety Foundation Newsletter, HealthLeaders, Managed Care Outlook and Becker’s Hospital Review. In addition, he has spent more than 15 years as the national speaker for the “Driving Responsibly” campaign.

Dr. Blomberg completed his training at Brigham & Women's Hospital, a teaching affiliate of Harvard Medical School in Boston in the Department of Anesthesiology, Perioperative and Pain Medicine. During his final year of residency, he served as Chief Resident. He is a graduate of the University of Miami School of Medicine in Miami, Florida.

Cindy Houck, CRNA, Platinum Award Winner

Cynthia Houck, CRNA joined Sheridan Healthcare in 1984 after graduating from George Washington University’s Nurse Anesthesiology Program. She has witnessed the growth of Sheridan from a small private anesthesia group to the nation’s largest anesthesia outsourcing provider.

Cynthia has served as the Chief of Allied Health at Memorial Regional Hospital, a 700-bed tertiary care level-one trauma center, since 1993. She has also been the Regional Director of Allied Health, South Florida Region since 2009. Her responsibilities include oversight of all Allied Health in Dade and Broward Counties, 14 hospitals and 6 ambulatory facilities. She was the Clinical Coordinator for SRNAs from FIU from 2006 until 2012.

In addition to her clinical duties, Ms. Houck is also co-chair of the Policy & Procedure Subcommittee for Quality Improvement

 

Dr. Gary Gomez, Innovation Award Winner

Dr. Gary Gomez has served as chief of anesthesiology at Memorial Hospital Miramar since 2013 and has led several clinical improvement projects. These include enhanced recovery after surgery protocols, PONV prophylaxis tools and i

ntrathecal catheter management protocols. He also was one of three lead physicians to develop the ClearPATh anesthesia patient readiness program and is currently collaborating to develop further clinical pathways as part of Sheridan/AMSURG’s nationwide initiatives.

Dr. Gomez received his medical degree from the University of Florida and is currently enrolled at UF’s executive MBA program. He lives in South Florida with his wife and three children.

Dr. Jonathan Katz, Innovation Award Winner

Dr. Jonathan Katz started with Sheridan eight years ago as a member of the cardiac team at a 227-bed hospital. He was promoted to vice chief a year later and has been a regional medical director for 1.5 years.

Dr. Katz graduated from the University of Pennsylvania School of Dental Medicine and got his medical degree from the University of Connecticut in oral and maxillofacial surgery. He completed his anesthesia residency at the University of Miami, where he served as chief resident and did his cardiothoracic anesthesia fellowship. He also worked as an attending in UM’s cardiac anesthesia subdivision and was assistant program director for the anesthesia residency.

 

 

Please join us in congratulating this year’s Sheridan Leadership Award winners.

15 August2016

Six Physician Communication Strategies to Increase Patient Engagement and Improve Outcomes

Effective physician-patient communication that builds trust and a shared sense of responsibility for the patient’s care is an increasingly important skill for physicians. Doctors whose communication fosters patient engagement has been linked to a wide range of benefits, from increased patient satisfaction, trust and higher quality of care to better patient adherence to treatment and improved physical outcomes. Communication skills are especially important in a hospital setting, which patients often perceive as more impersonal than a visit to their primary care physician’s office.

The challenge is that while the need to involve patients in decisions about their own care continues to grow in importance, the current health care environment – including shorter hospital stays, more complex medical care and a drive for efficiency – makes it harder to achieved good communication among providers, patients and family members.

The Negative Effects of Poor Physician Communication on Patient Experiences … and Outcomes

A 2015 study published in PLOS ONE synthesized qualitative studies exploring patients’ experiences in communicating with a primary care physician to identify the determinants of positive and negative experiences in physician-patient communication and their subsequent outcomes. It found that, overall, primary care physicians’ communications create more negative than positive patient experiences. Patients report that physicians usually lead consultations and sometimes in a paternalistic manner – deciding on the treatment plan without engaging the patient in a conversation about care decisions, asking too few questions or too many closed-ended question, and rushing through explanations of the patients’ illnesses while using complicated, unfamiliar medical jargon. Doctors often orient conversations toward physical symptoms without leaving room to discuss psychosocial aspects related to the condition. As a result, patients say they feel powerless, vulnerable and intimidated and, therefore, less likely to engage in their own care decisions by asking questions or volunteering psychosocial or other information that might affect their diagnosis or treatment. Those who attempt to address psychosocial issues proactively report being dismissed.

Patients say these negative experiences leave them feeling not only helpless, frustrated, unheard and unrecognized but also unmotivated to comply with their treatment plans.

While this study focused specifically on primary care doctors, these problems can be exacerbated in a hospital setting, where a physician-patient relationship may not have been established.

Communication Skills That Promote Patient Engagement

Patients also shared the communication-related skills they value most in physicians:

  • Empathy.
  • Careful listening.
  • An open mind.
  • Friendliness.
  • Compassion.
  • A genuine interest in the patient.
  • Attentiveness.
  • Willingness to ask questions and initiate conversations.
  • Investing time and effort to educate patients and make sure they understand the illness.

These skills are key to fostering collaborative, two-way communication and building trust and mutual respect – things that can provide important contextual information and enable doctors to do a better job of tailoring care and fostering patient engagement.

Cultural Barriers to Effective Communication

Ultimately, whether patients experience a physician’s communication with them as positive or negative is heavily influenced by the context of a patient’s individual background and values. Some of the ethnic minority patients report experiencing additional communication difficulties resulting from language barriers, discrimination, differences in values and beliefs, and acculturation-related issues.

The study offers several examples of how acculturation affects physician-patient communication. One such example is that Hispanic migrants to the U.S. say they need to develop a warm relationship with their physicians before they feel safe sharing private information, while U.S.-born Hispanics attach less importance to developing warm relationships with their doctors because they appear to understand that the physician’s primary role in this country is to heal.

Interestingly, patients who need to consult with informal interpreters during medical visits say those consultations make them feel embarrassed, guilty and uncomfortable. And, not surprisingly, the presence of an informal interpreter not only inhibits patients from discussing sensitive or mental health topics but also makes disclosing intimate information difficult or impossible.

Six Ways to Improve Physician-Patient Communication and Engagement

Solicit Relevant Psychosocial Contexts

Encourage patients to talk about psychosocial factors that might be related to their condition. Try to provide a nonjudgmental atmosphere to help make them comfortable talking about difficult personal issues.

Tailor Communications to Cultural Contexts

Develop a cultural awareness and understanding of the populations you serve and tailor communications appropriately to each patient’s cultural, values- and beliefs-based context to avoid inadvertently giving offense or causing mistrust.

Educate Patients on Care Best Practices

In a recent article in MedPage Today, Dr. Catherine Polera, chief medical officer for Sheridan’s Emergency Medicine division, describes how she uses effective communicate to bridge gaps in patient expectations. For example, patients who are diagnosed with bronchitis often expect a prescription for antibiotics, yet acute bronchitis is usually viral and, therefore, usually should not be treated with antibiotics. She finds that explaining the reason for her decision not to prescribe an antibiotic in that situation, using easy to understand language and showing patients evidence that supports her decision – using online sources they trust – helps educate patients and increase their satisfaction with the care she provides.

Educate Patients About Responsible Antibiotic Stewardship

This is also an opportunity to educate patients not only on their diagnosis but also on the evolution of antibiotic-resistant superbugs and the importance of responsible antibiotic stewardship on the part of both doctors and patients to slow that evolution.

Provide Compassionate, Personalized Care and Reassurance

A great example is radiologists Dr. Lynda Frye and Dr. Orna Hadar at the Jupiter Medical Center’s Margaret W. Niedland Breast Center, who understand that breast cancer screening is often an intimate, stressful experience for patients. To engage patients in their own care, both these physicians build patient relationships based on honest communication and trust, providing timely information and reassurance during what can be a frightening time. They read mammogram imaging immediately and discuss the results with patients. They thereby connect directly with patients and eliminate the dreaded callback to inform patients that they need to take more images. If more images or biopsies are necessary, Dr. Frye and Dr. Hadar will order them at that appointment. Additionally, they insist on delivering news to patients themselves to demonstrate their total commitment to the patient. Their compassionate, personalized care builds trust and encourages their patients to return for annual breast cancer screenings.

Provide Online Information Resources to Educate Patients and Set Expectations

Providing easily accessible, curated, topic-specific information can help reduce patients’ anxiety and properly set their expectations about medical conditions, recommended treatments and upcoming procedures. A good example of the latter is Sheridan’s Anesthesia Patient Education Portal, which not only explains the different types of anesthesia, the roles of anesthesia care team members, and what patients should expect before, during and after surgery, but also provides guidance on the types of questions patients may want to ask the anesthesiologist during the preoperative evaluation. Setting expectations, particularly around pain management, also can have a positive impact on patient experience and satisfaction

9 August2016

Technology Innovations That Will Transform the Future of Radiology

Advances in technology over the past two decades, from PACS systems to voice recognition software, have enabled significant improvements to efficiency and, in turn, patient care in the field of radiology. New technology promises to fundamentally change the practice of radiology, thanks in part to IBM’s recently formed Watson Health medical imaging collaborative. In a new article in Healthcare Tech Outlook, Dr. Glenn Kaplan, Sheridan Healthcare’s VP of Offsite Radiology Services, talks about how Sheridan and other members of this collaborative are working to leverage Watson’s sophisticated cognitive computing and cognitive imaging capabilities to help make radiologists better diagnosticians and physicians.

It’s common for referring physicians to provide radiologists with very minimal patient information on the order sheets, which often are missing relevant information that can affect the accuracy of the readings. This problem is frequently exacerbated by a lack access to that information because of system interoperability issues. But those issues could become irrelevant in the foreseeable future, thanks to the work of the new IBM Watson medical imaging collaborative. Watson is “a technology platform that uses natural language processing and machine learning to reveal insights from large amounts of unstructured data.” Members in the collaborative plan to make the most of its unparalleled cognitive computing capabilities, training it to help doctors provide more patient-specific care as it creates a continually growing knowledge base that can be used to improve care for broader patient populations as well as individuals.

One of the initiatives will be training Watson to detect abnormalities in radiology images, including things like subtle fractures that even a very experienced radiologist might easily miss and that could have major implications for the patient’s health, quality of life, and even life expectancy. Another is teaching Watson to prioritize cases that require emergent care. Ultimately, the partners hope to help Watson learn to understand and extract insights from X-rays, CT scans, MRIs and a variety of other unstructured imaging data, combine those insights with patient and clinical data from a broad range of other sources, and pull together the most relevant information for each case to help doctors make more effective and more individualized care decisions for their patients.

Learn more about the exciting work of the IBM Watson Health medical imaging collaborative that will pave the way for a new era of personalized patient care in Dr. Kaplan’s article “Technology Innovations That Will Transform Radiology and Patient Care.”

14 July2016

Jupiter Medical Center Radiologists Build Patient Trust to Improve the Mammography Experience

For many physicians, radiology is an impersonal specialty. Many radiologists read diagnostic imaging but never interact with patients. Orna Hadar, M.D., a mammography specialist at the Margaret W. Niedland Breast Center at Sheridan partner hospital Jupiter Medical Center in Jupiter, Florida, and Lynda Frye., M.D., Jupiter’s Medical Director of Breast Imaging, take a very different approach. They know the screening process can be terrifying and that for many patients, “having their mammogram is a completely anonymous experience. We want to change that,” said Dr. Hadar. Both doctors find tremendous satisfaction in helping their patients through the experience. “It’s such a scary time for somebody, so to be able to offer some support even just through my guidance and diagnosing … it’s just special for me,” Frye said.

Drs. Frye and Hadar develop meaningful relationships with their patients, and each assures her patients that their well-being is her top priority. These doctors know that it is important to many women that they receive news—whether good or bad—from a physician whom they see regularly, know and trust. They also know that the uncertainty a patient feels while waiting for the results is one of the most stressful aspects of a mammogram visit. So they insist on reading images immediately and bringing in the patient to discuss them. This not only allows patients to associate a trusted face with the diagnosis, it also avoids the need for them to return for another visit if further testing is needed. If additional images or biopsies are needed based on the initial reading, the radiologist will take them during the same appointment.

Not surprisingly, these doctors have a loyal following. In fact, Dr. Hadar, who previously practiced in New York City, has many New York-based patients who routinely travel to South Florida to see her for their annual breast imaging.

By developing trusted doctor-patient relationships, reducing the stress of breast cancer screenings and removing the inconvenience of callbacks for additional images or tests, Drs. Frye and Hadar encourage their patients to have mammograms on a regular basis. They are leading by example, providing a strong model for radiologists to deliver better care, improve efficiency (by eliminating the need for callbacks) and encourage patients to get regular screenings that can identify indicators of cancer early and enable more timely treatment and better outcomes.

9 June2016

Should the VA Use APRNs to Supplement Radiologists?

On May 25, the Department of Veterans Affairs proposed to amend its “medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.” The proposal comes amid a new push by the VA to maximize its available resources and improve access to timely healthcare services for the nation’s veterans without increasing costs. Public perception of the VA has diminished in recent years, as heightened media coverage of a 2014 scandal has highlighted a growing number of cases in which veterans are denied access to care.

This latest proposal would allow advanced practice registered nurses (APRNs) to "Order, perform, supervise, and interpret laboratory and imaging studies" without the supervision of a physician. APRNs would also be required to complete additional training to work at the VA.

With the ACR and the radiology community as a whole to the proposed ruling, many policymakers and healthcare leaders are asking if there is a better way for healthcare organizations to use their resources more efficiently.

Radiology is undeniably among the most complex medical specialties in healthcare delivery. Radiologists devote years to honing the skills necessary for accurately interpreting thousands of images a day. Many pursue additional training to become highly specialized in a single modality. Currently, there are very limited resources available for APRNs to develop such skills.

With healthcare organizations across the US struggling to maximize the capabilities of their available resources, physician extenders such as APRNs are increasingly being relied upon to fill the inevitable gaps in physician coverage. However, given the complexity and nuance implicit in the practice of radiology, the chance for catastrophic error cannot simply be ignored.

There is, however, growing evidence that technology-based applications will one day be capable of systematically analyzing the massive quantities of unstructured data present in electronic health records. Many experts have suggested that such technology could also be used to analyze visual data such as that of an imaging study. Is this the Holy Grail of modern medicine?

The answer for the foreseeable future is no. There is growing demand for physicians and allied health providers who possess the skills and expertise to usher in a new era of outcomes-based healthcare delivery. However, greater emphasis on cost containment will inevitably result in reduced wages, leading to slowed growth of the healthcare provider market.

With demand for quality healthcare services exploding without bound, the industry will undoubtedly look elsewhere for safe and cost-effective means by which to extend the capacity of physicians. Whether the answer is to expand the scope of healthcare providers, or to employ advanced technology, one fact remains: our role as healthcare providers is to improve the lives of our patients. 

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