Emmanuel Soto: How do you ensure that your team delivers high-quality, patient-centered care—something that doesn’t end up feeling like a cold treatment?
Denise Levy: I'm very fortunate to work with Dr. Bradley Hill, a Fogarty-trained vascular surgeon who worked with Dr. Fogarty for seven years. He and I share the same philosophy in patient care. The first step is to find out why the patient is there. What was the result of their CT scan? Did they have another ultrasound? What is their medical history? What are their risk factors? Taking just five minutes to gather this information can save you 20 or 30 minutes during the examination.
You need to assess whether the patient is improving or worsening. Did they have an intervention? Did they have a stent placed? Where was the area ballooned? These are the things you teach your students. I have students, and we've hired some of them because they have embraced our entire approach to patient care. It’s crucial to know what you're doing before you start with the patient, even before you place the probe on them. I always teach my students to welcome the patient and thank them for arriving on time. Thank them for not eating before the appointment [for example].
Knowing what you're looking for and understanding the results is invaluable because it allows you to tell the physician, "Yes, your surgery worked. We won’t need a follow-up for six months," or, "This patient does need surgery, and here’s what I found." We handle a lot of dialysis patients, and we see them from the vein mapping stage. It's crucial to spend time going through the protocol. Dr. Hill is an incredibly gifted surgeon, both in endovascular and open surgeries. There aren't many vascular surgeons left who can handle open surgery, but he is one of them, and he is incredibly well-trained.
It's important for me to feel like the person I'm collaborating with is approachable, that they won’t just say something short and walk away. Collaboration is essential, and that’s how I’ve avoided burnout all these years.
I once worked part-time for a group that would fabricate symptoms on a patient just to justify a study. I told them I wasn't comfortable with this because that diagnosis would follow the patient for the rest of their life and could affect their insurance. But they insisted, saying, "Just do it because I said so." And I said, "I really can't do this anymore. I have to resign."
I think I was making $50 an hour back then, and they offered to pay me $100 an hour [to stay], but I said no. I’ve never felt like I chased a job for the money; I pursued jobs for their quality. I stayed with people who were on the same page as me, focused on delivering good patient care. You don’t have to perform surgery if it’s not warranted.
Emmanuel Soto: Could you tell us about the strategies you employ to build and maintain a cohesive and high-performing imaging team? Also, how do you develop other leaders, as you've done in the past?
Denise Levy: People need to understand that their job is important, and they need the time to do it properly. A surgeon might have two to three hours to fix a leg in the operating room, but we only have half an hour. So, I impress upon my students and staff that, yes, you do need that half hour for the exam, and don't let anyone tell you otherwise. You have to stand up for yourself.
For example, when introducing a new skill in the department—like when we started using the wavelength with Bard for endovascular ablation instead of open surgery, which saves the patient from undergoing surgery—we had to establish guidelines and protocols.
All our protocols are programmed into the machines, guiding every ultrasound technologist through an examination, including annotations. That level of organization and clarity comes from leadership, from me empowering them by saying, "You can do this."
It's important to ask yourself: Are you working on the correct leg? Did you have lunch? Did you take a break? Do you feel calm enough to process the information? Because if you're too busy or distracted, you won’t have the concentration needed to do a good job. So, what I try to instill in people is confidence and the pursuit of better outcomes.
Emmanuel Soto: We often talk about burnout, but we sometimes forget to discuss ways to prevent it. As you're saying, leadership plays a significant role in providing that space and support, but it's also crucial for individuals to advocate for themselves. It's important to stand one's ground, and I'm sure that's how you've been able to develop other imaging leaders—by teaching them to advocate for themselves and prioritize patient care and quality.
Denise Levy: I always tell them, "You're in control. You wag the tail; the tail doesn’t wag the dog." People will try to take advantage of you, and that's just part of the human experience. But there are certain things you must check. For instance, we always check the deep system before starting a reflux study, which primarily focuses on the superficial system and then the deep system afterward.
We always make sure there's no clot. I've had a few patients where my students turned to me and said, "Hmm, Denise, I think we need to change the exam, don't we? This is now a deep vein thrombosis study instead of a reflux study." This patient had a clot in their popliteal vein.
If I had just started imaging back and forth, measuring length and cross-section without thoroughly examining the entire leg, I could have made a serious mistake if the patient had a clot further down. For example, I once had a patient who came in with a weak pulse. The reason for that weak pulse was that he had clotted his entire deep system, leaving no outflow, causing his arterial system to back up. I discovered this because, when I reached the popliteal vein, I noticed it wasn't compressing. I called his doctor and said, "We need a different order. We've done the artery, but now we need to check for deep vein thrombosis because he's clotted and has no outflow."
So, I encourage everyone to be curious. Talk to your patients, thank them for coming in, see how they're doing, and build a relationship. It makes the time go faster, and your patients appreciate it.
I don’t give them medical information; I tell them that Dr. Hill is the expert who will go over everything. That approach eases the process for them. I have patients who return all the time, some who I saw 20 years ago at other practices or hospitals.
I don’t know how to retire because I have so much fun.
