I was first hired in as a consultant, due to my military background, to have a look at WHY patients dreaded having an MRI scan.

In the military, they test people's ability to deal with uncertainty or scary situations. They have a number of ways of doing this, but principles were basically the same.

I like to use the self-determination theory as a framework to explain how they managed to create fear or angst, in a safe environment,  and then compare it to an MR scan. Later we will use the same framework to look at how you can reduce fear and angst among your patients.

Alone in the woods

During my military service, we were ordered to go into a room and we had to bring all our gear. We were then told to line up all the gear in front of us. We were not allowed to speak, nor communicate with anyone about anything.

At the end of the line was a black plastic bag. One of the officers started to name some of our gear. We were told to hold it over our heads and then put it in the black plastic bag. Then he named another one, and we continued the routine.

After stripping us from most of the "nice to have" gear - like sleeping bag, down jacket, matches etc. They told us to strip the bag and label our name on it.

It was then thrown into another room, and we were told to pack whatever was left. Once everyone was finished packing, we had to put a hoodie over our heads and sit on our bags. We were not allowed to move, or make any noises.

Then they threw us into a car, one-by-one, and drove us to somewhere unknown - blindfolded.

Suddenly they stopped the car, dragged me out and I noticed that we started to walk into the woods. The reason I noticed that was that the snow was up to my knees. And the temperature was about -14*C (6,8*F).

There, in the middle of nowhere, I was told to stay and survive until they came back and picked me up. I remember asking: "when will you pick me up?" - they kindly replied: "...we pick you up when we pick you up".  

Before he left he gave me a GPS alarm. "Press this if there is an emergency or you want to quit"

End of conversation.

The three basic needs

The self-determination theory is built around the concept that we humans have 3 basic needs.

1. The need for autonomy - the right of self-government, or choosing our environment
2. The need for competence -  knowledge, and experience to deal with the environment
3. The need for relatedness - feeling care for and connected to others

If we look at my situation, they not only stripped us from our gear, they stripped us from autonomy, put us in an environment with a limited amount of gear, and we're left out there alone. And before that, they made sure that we were physically and mentally tired. And I can't remember if we had food or not.

The question is: how would you respond if I were to put you in such a situation?

Comparing this to the MR experience

If we then compare this to the MR exam, we can find certain common treads.

Let's look at it from the patients perspective:

• They're not there because they want to be there
• Unknown environment - they don't have years of education
• Look at the door - would you like to go into a room with those stickers?
• Physically and mentally tired (due to sickness)
• They're there alone - they don't know you
• They're left alone in the scanner
• They're left with an alarm button

Is it any wonder that patients get afraid?

The fear of MRI doesn't make any sense when we see it from our perspective, but it sure does make a lot of sense once we see it from theirs.

Once you see the MR experience through the eyes of the patient, I believe you'll get the motivation and find the resource to improve it.

Increasing the 3 basic needs.

You can improve the experience by increasing the 3 basic needs.

1. The need for autonomy - creating an attractive environment.
2. The need for competence -  educating the patient before, and during the exam.
3. The need for relatedness - creating trust and letting them know that you care.

And that is what this whole course is about.