The patient experience has always been a core element of the radiography profession, whether diagnostic or therapeutic. Ultimately, that’s what it’s all about – making sure patients leave the hospital having received the care they need.
But how do radiographers ensure positive patient experiences? Patients on the radiotherapy pathway are often at one of the most difficult points of their lives. In light of that constant challenge, keeping the patient experience at the forefront is key for Therapeutic Radiographers.
But Lizzie Smith, team leader Therapeutic Radiographer at Worcestershire Royal Hospital’s Oncology Centre, has a unique perspective on the topic. Having been diagnosed with cancer in 2022, Lizzie underwent her own intensive course of chemotherapy treatment, which took her out of work for months. Instead of being disheartened, however, the time away from radiotherapy has only invigorated Lizzie’s passion for the patient experience.
Synergy visited Worcestershire Royal Hospital’s Oncology Centre to talk to Lizzie, and find out more about her perspective on ensuring a positive patient experience in light of her time as a patient herself.
‘I started to understand the fear of the unknown’
Having been part of the Worcestershire Oncology Centre since September 2014, Lizzie is well-versed in the processes, protocols and systems that need managing during the course of a typical day. Though the centre covers a number of modalities and techniques, her role is very much embedded within team management.
That responsibility became even more difficult when, at the beginning of 2022, she began to notice something was off. “Work was starting to get quite busy again,” Lizzie explains. “It was after Covid, though it was still present, and numbers [of cancer patients] were starting to build back up again. We were starting to treat people who had deferred their treatment because of the pandemic.
“I remember feeling a bit tired, but I thought that was just normal. We had worked over the pandemic, and now we were seeing an increase in numbers again – it’s just more tiring.”
But the feeling persisted. By March of that year, Lizzie was no longer well enough to come into work. At that point, she had no idea why. Over the space of the next two months, Lizzie received first an incorrect diagnosis and then eventually a correct diagnosis for Hodgkin lymphoma, at the age of 29.
During her chemotherapy treatment, Lizzie went into the Worcestershire Royal Hospital, but being there as a patient rather than as a radiographer left her feeling out of place and out of sorts. “I was coming into the hospital, but not coming in to work,” she says. “It gives you a different feeling, because you’re on that other side. I didn’t know why, at first, but I was coming into the hospital as a patient for the first time – not in the uniform, but as someone in the waiting room wondering what I’m here for, what’s going to happen.
“I started to understand some of that fear of the unknown that our patients tend to describe. I didn’t realise what it was like to have to actually wait in a waiting area.”
Lizzie describes how a lack of information about when she would get her appointment was anxiety-inducing. Not knowing why she was there at all only added to her discomfort – and it prompted her to think harder about how to make that experience easier for patients.
She said: “We never fully appreciate the other way around, it’s inconvenient for us but it can be really hard on patients. That experience [of being in the waiting room] really hammered it home.
“If we can even give a vague idea of who’s next, an estimate of how long it will take – that gives people just a little peace of mind. They know they can walk around and grab a coffee.”
The home team
Once she’d received her diagnosis, Lizzie began her six-month course of chemotherapy treatment at the Royal Worcestershire Hospital. She first met her haematology team, who asked whether she would prefer to be treated at the Oncology Centre, at her workplace and with her team, or if she would rather go further afield, to the Queen Elizabeth Hospital in Birmingham. Familiarity with her surroundings won out, and Lizzie remained at the hospital she’d worked at for almost a decade to receive her treatment. “It was quite nice to see familiar faces,” Lizzie admits, “and you have that sense of trust in them, because you already work with them and you know what they do. You already trust what they can do, because you’ve seen them do it with other patients.
“In a world that had gone upside down, that was what kept it level and calm. If I’d gone somewhere else, there would have been so much more to do and so many more people to meet. I think that adds to it a bit.”
Chemotherapy treatment kept Lizzie on the ward for several weeks, where she was fortunate enough to receive regular visits from her colleagues in the radiotherapy team. “It was something to look forward to,” she says. “You’re in an isolation room, and realistically they only allow healthcare professionals and one visitor in there – but luckily these guys counted as healthcare professionals!”
Lizzie’s course of treatment began in April 2022 and finished in November the same year, a schedule somewhat delayed in the final stages by back-to-back instances of sepsis causing complications.
The home team
Once she’d received her diagnosis, Lizzie began her six-month course of chemotherapy treatment at the Royal Worcestershire Hospital. She first met her haematology team, who asked whether she would prefer to be treated at the Oncology Centre, at her workplace and with her team, or if she would rather go further afield, to the Queen Elizabeth Hospital in Birmingham. Familiarity with her surroundings won out, and Lizzie remained at the hospital she’d worked at for almost a decade to receive her treatment. “It was quite nice to see familiar faces,” Lizzie admits, “and you have that sense of trust in them, because you already work with them and you know what they do. You already trust what they can do, because you’ve seen them do it with other patients.
“In a world that had gone upside down, that was what kept it level and calm. If I’d gone somewhere else, there would have been so much more to do and so many more people to meet. I think that adds to it a bit.”
Chemotherapy treatment kept Lizzie on the ward for several weeks, where she was fortunate enough to receive regular visits from her colleagues in the radiotherapy team. “It was something to look forward to,” she says. “You’re in an isolation room, and realistically they only allow healthcare professionals and one visitor in there – but luckily these guys counted as healthcare professionals!”
Lizzie’s course of treatment began in April 2022 and finished in November the same year, a schedule somewhat delayed in the final stages by back-to-back instances of sepsis causing complications.
Building back up
The journey to physical recovery, however, is just one aspect of Lizzie’s experience. “I don’t think you ever really recover. That’s still ongoing. Physically, about a month after, I started feeling better. I went through this continual cycle of getting poisoned, feeling unwell, feeling better, and then time for the next one,” she explains.
Having gone through that same cycle every month for six months, Lizzie says it was a major relief when it came to the last cycle and she realised there was no need for her to go through it again.
After that, she began the process of building back up from there. Support from transfusions and injections notwithstanding, it took a month for Lizzie to feel normal again after the chemotherapy had stopped. “That was when I started thinking ‘I feel normal, so it’s time to go back to work’,” she says. “I wanted to do normal things, socialise with friends – the things normal people do.”
Lizzie returned in triumph in December 2022, keen to return and avoid sitting and staring at four walls for days on end. Coming back to the radiotherapy team, initially Lizzie avoided patient-facing roles and anything clinical, working solely on administrative, back office work needed to keep departments running.
On her return to work, Lizzie was incredibly well supported by management and her colleagues. The department found a space for her to work where she would be at lower risk of infection, because of her still severely low blood counts. Management also told Lizzie they were happy to be led by her for her return to work. “I was desperate to get back to being patient facing,” Lizzie says.
“Thankfully, Claire and the management team slowed me down in my expectations to prevent me from making one step forward and three steps backwards. I’m really grateful that they enforced these adjustments.
“As always, they were right! I think I was trying to do too much, too soon. Their input has essentially meant that I have been supported back to fulfilling my team leader role.”
‘I’ve started to notice little things more – things I know make a difference when you’re in that situation’
‘I started to notice the little things more’
In April 2023, Lizzie began seeing patients once more, and immediately felt her attitude towards her job, and the people she regularly treated, had changed. “I started to have more appreciation for the journey these patients had been on, before they get to us, particularly those who had had chemotherapy. I started to notice little things – like their headwear, how their hair was growing back, how quickly their eyelashes were growing, things like that,” she says.
Now having personally experienced that journey, Lizzie found herself able to understand where patients were coming from in much greater detail. “If I know that patient finished chemo six weeks ago, I can think ‘they’ve got great lashes for six weeks post chemo!’” she says. “I remember finding it really hard to find pretty headwear. So when a patient came through I would say ‘oh, I really like your headwear’.
“It made them smile, and I started to appreciate how nice it was being complimented on one of the few things you’ve got control over. I’ve started to notice little things like that more – things I know make a difference when you’re in that situation, when you’ve been kicked down physically.”
Having worked in the radiotherapy department for more than a year since returning from her cancer treatment, Lizzie finds it easier to reflect on how her practice has changed. “My advice is a little better, particularly for patients who have had chemo or are on chemo. Something that works for one person won’t necessarily work for everyone but, if a patient is complaining of nausea, I can suggest the things that worked for me – salty food and fizzy drinks, for example.”
With first-hand knowledge of experiences, processes and medications, it has been much easier for Lizzie to understand the source of a problem and help give practical solutions. That change has made her advice much more well rounded. “As cliché as it sounds, always be kind,” Lizzie advises other Therapeutic Radiographers in the wake of her experience as a patient. “When you’re on treatment, you don’t necessarily remember every day, or the names of people, or their faces – but you remember the way they made you feel.
“If that person makes you feel comfortable or calm, you remember that it was a good day. You remember that nurse, that radiographer – they made me feel at ease. It’s quite easy in this job, because we’re so busy, to think of it as the next breast, the next prostate, and just get the next one in.
“It’s not that we’re impolite but sometimes we get an air of ‘hurry up’. From the other side, it is noticeable when people are tense. How you make people feel makes such a difference. You’ve just got to listen to what they say and find out what they’re feeling. How actually are they? Don’t ask just for the sake of asking. Is there anything we can help with from our end?”
‘I started to notice the little things more’
In April 2023, Lizzie began seeing patients once more, and immediately felt her attitude towards her job, and the people she regularly treated, had changed. “I started to have more appreciation for the journey these patients had been on, before they get to us, particularly those who had had chemotherapy. I started to notice little things – like their headwear, how their hair was growing back, how quickly their eyelashes were growing, things like that,” she says.
Now having personally experienced that journey, Lizzie found herself able to understand where patients were coming from in much greater detail. “If I know that patient finished chemo six weeks ago, I can think ‘they’ve got great lashes for six weeks post chemo!’” she says. “I remember finding it really hard to find pretty headwear. So when a patient came through I would say ‘oh, I really like your headwear’.
“It made them smile, and I started to appreciate how nice it was being complimented on one of the few things you’ve got control over. I’ve started to notice little things like that more – things I know make a difference when you’re in that situation, when you’ve been kicked down physically.”
Having worked in the radiotherapy department for more than a year since returning from her cancer treatment, Lizzie finds it easier to reflect on how her practice has changed. “My advice is a little better, particularly for patients who have had chemo or are on chemo. Something that works for one person won’t necessarily work for everyone but, if a patient is complaining of nausea, I can suggest the things that worked for me – salty food and fizzy drinks, for example.”
With first-hand knowledge of experiences, processes and medications, it has been much easier for Lizzie to understand the source of a problem and help give practical solutions. That change has made her advice much more well rounded. “As cliché as it sounds, always be kind,” Lizzie advises other Therapeutic Radiographers in the wake of her experience as a patient. “When you’re on treatment, you don’t necessarily remember every day, or the names of people, or their faces – but you remember the way they made you feel.
“If that person makes you feel comfortable or calm, you remember that it was a good day. You remember that nurse, that radiographer – they made me feel at ease. It’s quite easy in this job, because we’re so busy, to think of it as the next breast, the next prostate, and just get the next one in.
“It’s not that we’re impolite but sometimes we get an air of ‘hurry up’. From the other side, it is noticeable when people are tense. How you make people feel makes such a difference. You’ve just got to listen to what they say and find out what they’re feeling. How actually are they? Don’t ask just for the sake of asking. Is there anything we can help with from our end?”
Lizzie and SoR officer Laura Charlesworth at ARC
Lizzie and SoR officer Laura Charlesworth at ARC
From the ground up
Lizzie says she fell into radiotherapy almost entirely by accident. At school, before her GCSEs, Sheffield Hallam University offered an open day to help students without family members who had gone to university to understand what courses were on offer and what careers they could result in. The two Lizzie pulled out were for diagnostic and therapeutic radiography.
After some investigation, Lizzie was able to find work experience for radiotherapy, saw that she could make the necessary grades, and picked her subject list from there. She followed through with that first taste of radiotherapy and ended up studying at Sheffield Hallam itself, before doing her placement at St James’s Hospital in Leeds, where she qualified, and subsequently applied for everything she could find.
Originally she was offered a job in Middlesbrough, but she also received an unexpected offer from Worcestershire Royal Hospital’s Oncology Centre, which was not even open at the time. After an induction at Middlesbrough, Lizzie decided she couldn’t pass up the opportunity to get in on the ground floor in Worcester and work somewhere brand new.
While the Oncology Centre was being established, Lizzie worked in Coventry in partnership with the Oncology Centre, for around six months, where she developed her confidence and her competencies. Once the Oncology Centre opened, she moved over – where she has been working ever since. “It’s quite a small centre, and it opened literally as I started,” Lizzie says. “I’ve seen it from the ground up.”
At the Oncology Centre she worked her way up the ladder, before applying for her current team leader role during Covid. “I enjoy the job and I really enjoy seeing new people come in and develop,” she says. “I enjoy watching them turn into good radiographers who are able to provide the best care to our patients.”
From the ground up
Lizzie says she fell into radiotherapy almost entirely by accident. At school, before her GCSEs, Sheffield Hallam University offered an open day to help students without family members who had gone to university to understand what courses were on offer and what careers they could result in. The two Lizzie pulled out were for diagnostic and therapeutic radiography.
After some investigation, Lizzie was able to find work experience for radiotherapy, saw that she could make the necessary grades, and picked her subject list from there. She followed through with that first taste of radiotherapy and ended up studying at Sheffield Hallam itself, before doing her placement at St James’s Hospital in Leeds, where she qualified, and subsequently applied for everything she could find.
Originally she was offered a job in Middlesbrough, but she also received an unexpected offer from Worcestershire Royal Hospital’s Oncology Centre, which was not even open at the time. After an induction at Middlesbrough, Lizzie decided she couldn’t pass up the opportunity to get in on the ground floor in Worcester and work somewhere brand new.
While the Oncology Centre was being established, Lizzie worked in Coventry in partnership with the Oncology Centre, for around six months, where she developed her confidence and her competencies. Once the Oncology Centre opened, she moved over – where she has been working ever since. “It’s quite a small centre, and it opened literally as I started,” Lizzie says. “I’ve seen it from the ground up.”
At the Oncology Centre she worked her way up the ladder, before applying for her current team leader role during Covid. “I enjoy the job and I really enjoy seeing new people come in and develop,” she says. “I enjoy watching them turn into good radiographers who are able to provide the best care to our patients.”
A professional patient
Lizzie’s experience culminated in a hugely important moment at the 2024 Annual Radiotherapy Conference (ARC), organised by the Society of Radiographers and held in Brighton.
On the morning of the second day of the conference, Lizzie joined SoR professional officer Laura Charlesworth on stage to share her experiences as a ‘professional patient’.
Speaking to a large room filled with her Therapeutic Radiographer colleagues was a daunting prospect, but Lizzie’s message was an important one to share. “I was privileged to have been offered the opportunity to speak at ARC on my views as a ‘professional patient’,” says Lizzie.
“Initially I was very nervous at the thought and I didn’t think I had much to offer. However, after some gentle persuasion by the lovely folks at the SoR, I accepted the opportunity. As with most advocacy work, I was keen to make a difference.
“Since the keynote session, I have had some heartwarming feedback from those in attendance. I’m over the moon that people were able to take something away from the session that they can use to improve their practice.”
More about Lizzie Smith
Born and raised in Yorkshire, Elizabeth Smith trained locally before moving to the West Midlands, where she now works at an Oncology Centre.
Lizzie recently completed her MSc in Enhanced Radiotherapy and Oncology Practice and is working towards publication of her thesis. She has also won an award locally for Best Services for Local People, having been part of a team that creates and leads radiotherapy information open evenings.
Lizzie is a patient advocate for the West Midlands Cancer Alliance following her own diagnosis and treatment of cancer in 2022. She also works with a number of blood cancer charities to create awareness of the signs and symptoms to look out for, as well as mentoring those recently diagnosed, and writing their radiotherapy-specific patient materials.
Lizzie also spoke at this year’s Annual Radiotherapy Conference about her experiences with cancer as a Therapeutic Radiographer.
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