2017 - Page 3 of 11 - RadsResident

Posted on October 22, 2017March 31, 2022 by Barry Julius

How To Avoid The Second-Guesser Syndrome

Most of us know other radiologists that fit into the category of second-guesser. Perhaps, you trained or are training under someone like this. Consistently, they debate whether to call a pulmonary nodule or vessel on every other chest x-ray. Or perhaps, when a nurse asks a question about intravenous contrast amounts, they equivocate for what seems like hours. Clinicians don’t know how to proceed. The staff becomes upset. Worst of all, even though these radiologists tend to be very smart, they are targets to lose their job because no one is comfortable with their decisions. You know the type. In today’s post, I will give you some tips to avoid becoming a second-guesser.

Think In Terms Of Highest To Lowest Probabilities

Second-guessers often think about differentials that could be this or that with no differentiation between “this” or “that.” What do I mean? All the different options have the same probability as one another. It is rare for all the differentials to be just as likely as one another in the real world. In less than one out of a hundred cases, there are multiple diagnoses with equal probability of an outcome. So, if it makes sense, stick your neck out a little bit in your conclusion and make your impression the most likely diagnosis. Mention the differential in the comments sections with a description of what is most likely, less likely, and outright unusual. Typically, you will find that you are hemming and hawing much less.

Little Decisions Deserve Little Time; Big Decisions Deserve Big Time

When a nurse walks into the room to ask you how much contrast you should give to a patient with a GFR of 59, you need to decide quickly. Sure, it is somewhat important. We do not want to cause a patient renal failure. But, the difference between giving a patient 100 ccs versus 75 ccs of contrast is unlikely to make much of a difference. This decision is worth no more than 10 seconds of my time in my book.

On the other hand, let’s say you need to decide whether you should biopsy a lesion in the liver. Now, this decision has significant consequences. Biopsies can cause bleeds, infections, and more problems. You really may need to spend some time making this decision. If you have to think through the problem for a while, it makes some sense.

Don’t confuse the little decisions with the big decisions. It goes a long way to preventing you from transforming into a second-guesser.

You Can Miss Em’ Fast Or You Can Miss Em’ Slow

A great radiologist from my residency quoted me the following as he scrolled through a panel of plain films very rapidly, “You can miss em’ fast, or you can miss em’ slow.” I take this statement to heart. Sometimes, when reading cases, there comes the point that looking at a film for a while longer makes no difference in terms of perception. Your first look can be your best look. During the first few milliseconds of looking at a film, your brain unconsciously analyzes the film and can tell if something is off better than staring at an image for hours. Use your gut. Don’t perseverate too long!

Not Every Pixel Is The Same

What do I mean by this? Certain parts of a study are high yield, and others are low yield. For instance, in a patient with breast cancer, metastatic disease likes to go to the bone and liver. So, spend more time looking at these organs. On the other hand, metastatic breast disease does not tend to spread to the spleen. So, use your time accordingly. Spend the appropriate amount of time on each pixel. Pixel selectivity is a tool to prevent you from second-guessing yourself.

If All Else Fails, Make A Decision

Finally, sometimes there are no right or wrong answers. Although not perfect, both directions will allow the clinician to proceed appropriately with a workup instead of perseverating. Sometimes, clinicians need that push to do the right next step for the patient. In this situation, go ahead and make a final decision. You’ll be glad you did!

Avoiding The Second-Guesser Syndrome

Sound advice for avoiding second-guesser syndrome is not emphasized in the radiology curriculum. That’s why I’m here! So, avoid the pitfalls of the second-guesser. Go ahead and create a differential with your most likely diagnosis; utilize the appropriate amount of time for the decision, go with your gut, and spend the right time on each part of the images. You, too, can avoid the second-guesser syndrome and become a decisive radiologist!

Posted on October 18, 2017 by Barry Julius

Loss Of A Pet- A Lesson All Residents Can Learn About Quality Of Life

Today’s post is not for everyone. For those of you that have never owned a pet or do not understand why anyone would decide to keep a pet, especially during residency, you can stop reading here. But for those of you that take a keen interest in living with a pet of some sort, I think you will find this post very enlightening.

Most posts I write are not personal. Today’s post is very different. It serves several purposes. First, I aim to show my readers how we dealt with a sick beloved pet during the past few weeks in order to give examples of tough decisions that need to be made. Next, I am going to translate this episode into a life lesson about maintaining a good quality of life, translating it to residency. And finally, more importantly for me, I am going to be a bit selfish and eulogize the recent loss of my best friend and dog, Otis. The past few days have been some of the most difficult days of my life. I already miss him dearly.

The Ultimate Responsibility of Pet Ownership- Our Story

When we decided to commit to getting a dog, we committed ourselves to its entire life. We are ultimately not only responsible for feeding, comforting, bathing, and taking our pets outside but also the decisions we need to make when facing an inevitable loss. The difficulty is only compounded when you are training during the incredibly busy time of residency.

In our case, our incredible dog, Otis, had an episode of spontaneous agonal breathing. Like a madman, I rushed him off to our car and drove him to the animal hospital nearly 70 miles per hour through side streets. I passed him off to the technologist like a football so that the emergency veterinarians could instantly treat him. And, they treated him rapidly and professionally with a pericardiocentesis to drain off fluid during an episode of pericardial tamponade. While performing the ultrasound, the sonographer discovered a right atrial mass. Then, in the morning, the veterinarian radiologist scanned his abdomen, only to diagnose him with splenic nodules as well. They declared that he had untreatable metastatic hemangiosarcoma, a terminal cancer of dogs. It would consume him possibly in days or weeks, and if we were lucky, months.

We faced the ultimate decision after the veterinarians stabilized him. What do we do next? Do we bring him home now? Should he be euthanized? I couldn’t bear to say goodbye at this point because he seemed like he returned to his normal self for the time being. We decided to bring him home, hoping he would have a few more good weeks, maybe months.

The next week was one of the best weeks I ever had with my dog. We walked, let him roll in the grass (his favorite activity!), and allowed him to sniff just about everything. It was great. But, the day of reckoning finally arrived too soon. This time, the whole family came with him to the hospital after we noticed some subtle discomfort and worried that he was to become unstable.

The Big Decision- Quality of Life Issues

We knew at this point we had the big decision to make. Do we treat him with serial pericardiocenteses aware that the fluid accumulation and new episodes of pericardial tamponade would become more and more rapid? Or, was it time to say goodbye? We based our final decision on his quality of life. We had to say goodbye.

It was one of the most gut-wrenching decisions, I ever had to make. He was my best friend on earth. We slept on the same bed, traveled together, and ate meals with each other. He was always there for me over the past 10.5 years. It was his helplessness and innocence that pulled at my heartstrings. And now, I had to put him down. It was for the best. But, it made the decision no easier.

Life Lesson

What is more important than the quality of life? Whether it is a person or a pet, it does not matter. We need to do for our loved ones what is right for them and not for ourselves in the moment.

Translated into the residency experience, we should always think about the quality of not just our own lives but also the quality of life for our spouses, relatives, friends, family, and beloved pets. It’s not always about reading the most cases, staying late every day, only to miss out on our loved ones as time passes by. Bottom line. We need to sniff and smell the roses, just like Otis always did.

Ode to the Memories of Otis

You were the size of a toy truck when I picked you up in Charlotte, North Carolina over 10 years ago. You lovingly sniffed me and graciously accepted me into your life. I thank you for that.

Driving home from the airport, you slowly pushed open the Sherpa bag with your nose as I drove you to our house to see what was happening. Your curiosity was always without boundaries. I thank you for that.

Rolling in the grass was your heaven. You could always spontaneously enjoy the moment. I thank you for that.

When other puppies would bite the hands of their owner to get a treat, you would make sure to take the treat carefully always making sure that we were OK. You were always like that in your life. I thank you for that.

Sitting crosswise, you were always there to protect the kids. I thank you for that.

Good-natured and non-aggressive, you were beloved by all the people and canines you have ever met. I thank you for that.

For all the wonderful memories we had together over the past ten years, I wish we had more. Your life was too short. And, we will miss you dearly. The great memories of you will last our lifetime and beyond. I thank you for that…

From Your Beloved Family- we give thanks for every moment we shared together. Rest in peace…

Posted on October 14, 2017April 14, 2022 by Barry Julius

How-To Procedure Manual For The Klutzy Radiologist

Some of us are not born to be athletic and coordinated like Michael Jordan or Pele. It’s just not in the cards. As a part of this group, I can remember many simple radiology procedural activities challenging me that would make the average resident wonder! Simple things like putting on sterile gloves and coiling interventional wires seemed like rocket science. However, hope springs eternal. And, believe it or not, many strategies exist to allow the klutzy radiology resident to become an expert at performing a procedure. We will discuss these today in this mini procedure manual.

Read Everything You Can About The Procedure

Procedural work is not just about performing manual tasks. It involves significant preparation and planning, both from a hands-on and an intellectual standpoint. Therefore, your role is to know all you can before performing the procedure. Some of the questions you need to be able to answer before any procedure include: What is the reason for the technique? Is it appropriate for the patient? What are all the tools and equipment needed to complete it? How can you avoid complications? And, if a difficulty arises during the test, do you know what you have to do next? And, of course, what are the appropriate ways to manage the patient after you have completed the procedure?

In addition, nowadays, most procedures have an associated “how-to” article or procedure manual in the literature that can help you understand step-by-step how to perform a technique. Not only do you want to read each of these articles, but you also want to live and breathe all the information in it. What do I mean by that? If you can, mentally picture yourself performing the procedure steps before stepping into the interventional suite.

Gather All The Relevant Patient Information

Patient research beforehand can be just as important as the procedure itself. You need to be able to complete the appropriate test for your patient. If not, you can cause additional radiation exposure and potentially irreparable harm.

Therefore, gathering relevant patient information is essential before performing any procedure. What do I mean by that? Here are some of the pertinent questions you want to answer. Does the reason for the technique match the history of the patient? Is the patient able to consent? Are all the appropriate blood tests completed before starting it? Do you know of anything about the patient’s history that would increase the likelihood of complications? And so forth. Ensure that if your attending asks you something about the patient before its performance, you know the answer. It will come back to bite you if you don’t.

Practice Outside The Interventional Suite

As Malcolm Gladwell states in his book Outliers, you need to do something 10,000 hours to become an expert. Therefore, your work mustn’t end after the initial steps. If you have problems coiling a wire, practice the maneuver at off-times at work or home. When you have difficulty putting on sterile gloves the right way, take a pair and practice. If you have problems with suturing, learn needlework. Especially if you are not a member of the athletic/coordinated club, you will need to practice, practice, practice until you get it right!

Volunteer Ad Nauseum

Lastly, you need to develop the qualities of grit and perseverance. When a procedure is available, take the opportunity to participate. Don’t be a wallflower. One of my program directors during my residency repeatedly stated, “Radiology is not a spectator sport!” He was right. Procedural comfort is directly related to the number of times you have completed a procedure. So, go forth and participate as much as possible!

Read This Procedure Manual Again If You Have Doubts!

Everyone has some deficiencies, and we are not born perfect. We need to proceed with hard work and determination to overcome these weaknesses. Procedural skills for the klutzy resident are no different. So go forth and read avidly about procedures, gather the appropriate patient information, practice outside the interventional suite, and volunteer repeatedly. No matter if you are a bit klutzy. You, too, will have the power to master any procedure if you follow these basic guidelines!

Posted on October 12, 2017February 3, 2022 by Barry Julius

Radiology Swap- University Radiologist Goes To Private Practice (Part 2)

Today we return to Part 2 of our Radiology Swap blog. Click on Radiology Swap- Radiology Private Practitioner Goes To University (Part 1) to catch up if you missed the first part of Radiology Swap!

University Radiologist Goes To Private Practice

Day 1 Radiology Swap:

Unaccustomed to working in a private office, the University radiologist is surprised by the relatively small size of the office. The parking lot is not too full, and he can walk rapidly from his car to the office, very different from usually having to walk from the back of the parking lot—a nice perk.

Finally, entering the building, he locates his workstation and seat. As soon as he sits down at the desk with the PACS monitor, a technologist dumps a stack of papers with today’s work next to the monitors. It must be about 150 cases. Where are my resident and fellow? I need them to help me with the dictations! Oh, my God!!!! I just realized that I forgot how to use a dictaphone.

After struggling with dictations and having read maybe 10 of them, 11 AM rolls by as he teaches the technologists about the ultrasounds they show him. But, the technologists roll their eyes as they just want to get through the cases so they can go home. They sense him droning on and on! He looks at the stack of papers given in the morning. It still looks the same!

Noon: He begins to receive phone calls, not happy ones. Clinicians are asking him about the results of chest x-rays, ultrasounds, and MRIs. Unsuccessfully, he tries to soothe them and let them know he has not looked at them yet, but he will get to them! No lunch for me.

Eyes reddened, head bleary, and voice cracking, the University radiologist now realizes it is almost 5 PM. He has only finished maybe half of the stack of orders. Lots more to go. No one to talk to. I can’t leave yet to get to the family.

10 PM arrives, and he is finally finishing his last dictation of the “day.” How does the private practice radiologist do it?

Day 15 Radiology Swap:

He arrives wearily into the office, looking haggard and worn with a 15 lbs weight loss since he started the job (1 pound per day!). His temper flares every once in a while, taking out his frustrations on the constant bombardment by the technologists by making snide remarks and yelling at the staff’s mistakes. For the past 15 days, he has left the office in the dark, no earlier than 8 PM. No direct contact with interested learners or other clinical physicians. All interactions on the phone. So, this is physician burnout!

Day 30 Radiology Swap:

Assessment day for Radiology Swap!!!

Practice President: So, you have worked in our practice for the past 30 days? Let’s start with the good part: I’m glad to see that you have made it through the encounter.

Academic Radiologist: Yeah, barely. How do you guys do it?

President: We do it efficiently to make money. The more we read, the more we earn. It keeps us going. In any case, let’s continue with your review. We received many complaints from our staff that you were curt and inappropriate at times. It was like pulling teeth to get you to do fluoro cases on our patients. You kept on grumbling- “Where’s my resident?”

Academic Radiologist: I thought you would at least provide me with a physician assistant to help with daily work. I don’t usually touch patients. My residents do it for me.

President: We also received numerous complaints from our referrers that they did not receive their reports in a timely fashion. We lost some serious business this week.

Academic Radiologist: When you get 150 new studies per day, everyone has to wait!!!

President: I don’t think we would be able to keep you here because we need radiologists to keep up with the work. We don’t get paid if we don’t read the minimum volumes!

Academic Radiologist: The best part of this job was the 15 lbs weight loss! I can finally get some sleep again. His eyes begin to close, dreaming about returning to his academic position.

The Radiology Swap Meetup

So, the academic and private practice radiologists now seat themselves in the same room to share their experiences after having returned to their respective jobs.

Private Radiologist: How do you do your job on a daily basis without getting totally bored?

Academic Radiologist: How do you do your job without getting totally burnt out?

Private Radiologist: Let’s agree that we are not right for each other’s jobs. It would never work out for us.

Academic Radiologist: At least I can understand what you go through on a daily basis. We used to make fun of private practice radiologists. Don’t think that I will do that anymore.

Private Radiologist: Doesn’t mean that we can’t be friends. Let’s go out for drinks! I think we both earned it…

Academic: True. We both earned some stiff ones.

The radiologists leave the room and head down the street, never to look back on their former residency swap experiences again and happy to go out for some drinks…

THE END

(until next time!)

Posted on October 8, 2017May 24, 2023 by Barry Julius — 3 Comments

Want To Be A Successful Radiology Resident? Learn To Triage!

When program directors hear complaints about their residents, we find most do not stem from resident incompetence. Nor do the complaints relate to professionalism issues. Instead, a good majority arises from a lack of a timely response to reading cases. And these delayed reports result from a lack of appropriate triage. So, I think you know what we will talk about today. You guessed it! The topic is tadaaaa… how to triage your cases.

A Common Scenario

It’s 2 AM, and a bleary-eyed resident starts to pick off STAT CT scans from the worklist to catch up on his reading from the nighttime. A house physician rushes down from the floors to speak with the resident in a huff. She explains that she needs to discuss a case from a week ago that she must present for the tumor board the following day. The resident obliges. Thirty minutes pass, and the house physician leaves.

Next, a few minutes later, an ultrasound technologist stops by the reading room because she questions whether a renal cyst is simple or complex. Like a robot, the resident scans the patient in the ultrasound room to make the determination. Another 30 minutes go by.

While scanning the patient, the resident gets two beeps which he needs to call back. He gets to both those phone calls. One of the phone calls comes from a patient’s father, who asks a question about his son’s chest film from the previous day. The conversation drones on for 15 minutes, and the resident can barely get off the phone. But he does eventually. Right afterward, he quickly responds to the other phone call and promptly answers the nurse’s question on the other end.

The resident starts to reread the CT list, and a technologist interrupts his train of thought as he walks into the room. Solemnly, the technologist asks, “How much contrast should we give this patient with a slightly low GFR?”. Immediately, the resident attends to the technologist. However, the resident is unsure and looks through the literature to find the appropriate answer. After 10-15 minutes, he finds a piece of paper and says, “75 ccs of Visipaque.”

Finally, an angry emergency department attending calls to the radiology reading room, “Where the hell are the results from the nighttime CT scans? We have been waiting 4 hours. Sorry, but we are going to have to write this up as an incident in the morning!” Where did the time go by?

Ways To Triage In The Above Scenario

So, what could this poor weary resident have done differently to prevent himself from getting written up by the ER doc? Well, lots of things. For one, did he have to review the tumor board case with the house physician? No. Should he have spent 30 minutes determining whether the renal cyst was simple? Probably not. The resident could have delayed until the morning. Did the resident need to speak to the patient’s father for so long? I don’t think so.

To summarize some of the problems the resident experienced with triaging in the scenario above, I have divided some of the main concepts about radiology triage into the following paragraphs. Here are some general recommendations for triaging cases to avoid situations like this.

Keep Your Eye On The Prize

Remember… When you are on call, the first goal is not to kill anyone, and the second is not to injure anyone. By ignoring the STAT list and tending to other people’s “problems,” you are increasing your chances that something terrible will occur. Perhaps, the CT Abdomen/Pelvis for appendicitis with a positive study will get delayed. Or, you will miss that opportunity to catch that hemorrhagic stroke before it is too late. Delaying STAT reads can theoretically cause irreparable morbidity to your patients. Therefore… Keep your eye on the prize. Complete those studies that are urgent first!

Also, if the activity is not critical, you can delay it until the following morning. In the case of the ultrasound technologist questioning a cyst above, sure, it is an important question to answer. But not so much when you have a list of 5 or 10 STAT CT scans you need to look at. You always have the option of delaying such study until the AM.

It’s OK To Say No

At nighttime, you are going to get all sorts of requests. Some are important, and others are nonsense. Do not let your colleagues bully you into concentrating on peripheral activities that do not directly affect patient care. If you don’t have time to look at that tumor board case, simply say so. Sometimes saying no is just the right thing to do.

Attend To Your Study First, Then Your Colleagues

According to my previous blog, Should Radiologists Ignore The Phone?, residents pay a significant penalty when discontinuing their thoughts midstream. Error rates increase dramatically. More relevant to this post, however, the time to complete a study increases significantly, increasing your chance of causing an angry ER physician. Therefore, it is imperative that you briefly let your colleagues know that you need to complete the study first and will answer their questions as soon as you finish.

Triage And You

One of the most essential facets of the nighttime experience is learning to triage. Believe it or not, you will use these skills for the rest of your career regardless if you take call or not as an attending. What studies do you need to complete first? Who should you attend to? These are all triaging skills you need to learn to succeed. Using some basic triage concepts above, ensure your nights are shorter and safer!

Posted on October 5, 2017January 26, 2022 by Barry Julius

Radiology Swap- Radiology Private Practitioner Goes To University (Part 1)

Ever watched the show called Wife Swap? Essentially, women of two households “swap” roles and responsibilities for different families and share their experiences with the TV audience. It’s a lot of fun to watch! Like this exercise, I thought it would be fun to speculate on what would happen if you swapped a private practice and academic radiologist for a month. How would each experience the other’s world? What would be the trials and tribulations? Let’s see!!!

Radiology Swap- Private Practitioner Goes To University

Radiology Swap Day 1:

The private practice radiologist walks into his university radiology reading room for the first time. Looking around, he encounters a group of 2 medical students, one resident, and one fellow waiting for him to read out the films from yesterday evening and the morning. He thinks: Why are all these people here? Do I need four additional trainees to look at the ten cases left over? This excess is sort of ridiculous!!!

He begins to sort through the pre-dictations of the radiology resident and fellow. As the cadre of 4 trainees looks over his shoulder, he looks at the first dictation and decides to erase everything. Although he feels a little bit self-conscious from all the stares over his shoulder, he starts all over from scratch. He doesn’t like the way the resident words the dictation. It’s too freakin’ long. Rapidly, he runs through each resident and fellow’s cases, erases each, and re-dictates everything.

Only a few additional cases come through the department, and the resident/fellow handles each before looking at the images. They are tertiary referrals from another facility and are very complex, but he does not perseverate and completes the cases in 30 minutes. Staring at the clock, he begins to walk around. Well, not much going on. I’m going to grab some breakfast!!!

After grabbing breakfast for 15 minutes, he arrives back at the reading room. Two more cases show up. The residents, fellow, and student seem to wait for the radiologist expectantly. Again, he promptly erases the resident and fellow dictations and quietly reads the two cases very slowly with the team, trying to pass the time. This day is Chinese water torture! Learning to run intermittently once every few hours from his office to the reading room, the day continues, as is, until work ends at 5 PM.

Radiology Swap Day 15:

It’s the weekly admin slot. On the schedule today, the radiologist attends a tumor board with bleary eyes at 7:00 AM. Not accustomed to the so much time spent on each case, it is hard for him to stay awake. But he manages. Next, at 8 AM, he attends a meeting to discuss performance reviews for the technologist staff. For half of the conference, the attendees discuss when the next meeting will occur. Ugh!!! What a waste of time!

He quickly dots off to read a few films to help out his colleagues instead of perching himself at his desk to write a grant. He has writer’s block. What the hell should I be writing now? I haven’t written anything but a dictation for 20 years!!! He sits and sits and finally falls asleep at his desk.

Noon arrives. Thank God it’s lunchtime. Something to do!!! He happily runs down to the cafeteria to eat. He stretches out his lunchtime meal for one hour when the next meeting starts. Quality improvement initiative is the theme of the next conference. Could they think of a more boring topic to meet about?

It’s now 3 PM. He begins to meet with the backup staff in the department to discuss increasing resident and attending research output. This group includes the research coordinator, the head of research, the research financier, and the student research liaison. A recurrent thought flashes through his mind during the entire meeting. Who pays for all these extraneous people and why? I would cut the fat here immediately if I could!!!

Radiology Swap Day 30:

Assessment day! The department chairman sits the private practitioner down to summarize the events that ensued over the past month. The conversation goes something like this:

Chairman: I am impressed that you got all the work done quickly. They can be challenging cases. Our other academic radiologist never seems to get to read all the films.

Private Radiologist: Really? He only read 20 films per day!

Chairman: However, you did not apply for one grant; you did not even start on one paper. And, the physicist caught you sleeping at several meetings. Publish or perish!

Private Radiologist: Well, it’s challenging to write anything when you haven’t written a paper for over 20 years! How do you not sleep when half your meetings are about when the next meeting will be?

Chairman: And, your student, residents, and fellow claim that you rewrite all their dictations. You then grumble how they don’t know how to dictate and forget that they are there. Teaching is an integral part of academic radiology.

Private Radiologist: I don’t understand why they have to be there. They don’t do anything but stare over my shoulder!

Chairman: Although you can make it through all the films, your academic prowess is very poor. Academic radiology is not for you.

Private Radiologist: Thank God I can return to my private practice tomorrow!

See you next week for part 2!!!

Posted on October 1, 2017January 20, 2022 by Barry Julius — 1 Comment

Ten Things Radiologists Cannot Tell The Ordering Clinician (We Wish We Could!)

As residents and radiologists, we have all experienced frustrations that we cannot verbalize to an ordering clinician for fear of retribution. Perhaps, the ordering clinician may stop referring patients to us. Or, just maybe we will get written up in the middle of the night for performing unprofessionally. That would end badly! Regardless, I have created a list of ten things that all radiologists and radiology residents wish we could tell you, the ordering clinician, but cannot quite get up the nerve to do so. So, here we go.

Examine The Patient First

How frustrating is it that patients get a hepatobiliary scan to rule out cholecystitis, only for us to discover afterward that the patient had a cholecystectomy? Or, we receive a CT scan to rule out appendicitis, only to find out there is no appendix! Come on, guys, do your due diligence, PLEASE!!!

Throw Me A Bone- Give Me Some More History

You ever heard that saying called GIGO- garbage in, garbage out? Well, that certainly applies to us! Please, no more clinical histories with abnormal clinical findings or rule out? What does that exactly mean? If you want your reports to be somewhat valuable, throw us a bone!!!

I Cannot Read Your Handwriting- Write Something Legible Next Time.

Ever consider the amount of time we waste trying to mull over what you wrote on the prescription? Precious time that we could have used to get home earlier lost! Did you write CT w/ for contrast, or does CT w/o mean without contrast? This stuff matters!!!

Get An Answering Service, Bub!

Yes, there are times that we need to contact you. One of the most frustrating things in the world is to make that phone call that your patient has a pneumothorax only to find you, the ordering clinician, are out to lunch without anyone to contact. Please, please, please. If you are not around, find us someone who is covering!!!

Don’t Kill The Messenger

Hey, guys… We are only trying. Don’t get angry with us when we are doing you a service by letting you know that patient has an unforeseen pulmonary mass. Or, maybe we want to tell you that your patient has acute appendicitis. I don’t care if you are on vacation when we get you on the phone. Please show us a little bit of respect!

Just Provide The Relevant Facts, Man, We Don’t Have All Day!!!

We, too, have studies to read and patients to see. Could you not keep us on the phone? We have to hear about all the patient’s irrelevant labs, history, and physical examination. Keep it short and sweet, folks. We have lives that we would like to lead!

Don’t Send Us Your Patients At 4:55 PM!

Why do you like to send us your patients right before we are about to leave? Well, maybe, that patient with a GI bleed that you don’t want to work up because you want to go for the day. So, you send that patient for a GI bleeding scan instead of an endoscopy that you would typically do. The patient gets extra radiation, and then you delay the final diagnosis. Is that good patient care? NO!!!

We Are Not The Hospital Dumping Ground- Take Care Of Your Patients

So, your patient is giving you anxiety because he is combative on the floor. Therefore, you send the patient out to get a test so you can get a breather. Well, if you can’t handle your patients, we certainly can’t control your patient when they need to stay still. We are not the hospital dumping ground. At the very least, give your patient a valium if you send them down to our department!

If You See Us Dictating- Don’t Interrupt Us Until We Are Done!

You wouldn’t stop a surgeon in the middle of surgery. So why the heck would you want to interrupt us in the middle of our dictation? We provide essential information to our clinicians, and studies (1) show that interruption prevents radiologists from making all of the findings. Please… Appreciate what we do!

Give Us A Chance To Look At The Films Before Coming Up With A Final Opinion

So, you came down to our department to talk to us about the study you just ordered. Maybe, it is a CT scan of the abdomen and pelvis. Or perhaps, an MRI of the knee. If you know the nuances of reading these studies and you are telling us all the findings, then why did you come down in the first place? Did you do a 4-year radiology residency already? I think not. Give us a chance to make the correct diagnosis, not the one you want to tell us!

Final Words To The Ordering Clinician

We are clinicians, too, so we appreciate some professional courtesy. Do onto others as they would do to you!

http://www.academicradiology.org/article/S1076-6332(14)00307-9/fulltext?cc=y=

Posted on September 28, 2017August 14, 2020 by Barry Julius

Happy One Year Birthday To Radsresident.com!

My Birthday Balloons!

Personally, I think it is very important to celebrate momentous occasions. And for me, this is certainly one of those times! I am proud to announce that my blog- radsresident.com has survived to its one-year-old birthday. And, there are lots of folks that I would like to thank. Of course, I would like to appreciate all the authors, commenters, critiquers, email writers, and posters who have added immeasurably to the quality of this website. And most importantly, I give my heartfelt thanks to all my loyal readers who have encouraged me to keep this blog afloat.

For this post, I would like to share with you some of the statistics for the year and recount some of the sentinel events. And, I am also going to mention some of the future plans for the website.

Statistics For The Past Year

I am a lover of statistics and if you are into statistics, writing a blog is heaven. Some of you may be curious as to who reads the website, the most popular blogs, and more. So, I will give you the lowdown as of the blog’s first birthday. Let’s start at the beginning.

Over the past year from September 24, 2016, through September 23, 2017, I have had over 68,700 page views and 34,800 individual visitors arrive at my site. Out of the 68,700 page views, about 60 percent of the hits are from the United States. The other countries in the top 5 to visit my site are India (10%), Canada (2.7%), Pakistan (1.6%), and the United Kingdom (1.4%). Most countries throughout the world are also represented.

How do folks find my site? Well, 34% find my site through search engines, 31 % land on my site through social media, 30% arrive at my website directly, and 6% are referred from other sources such as Aunt Minnie.

In total, we have published 105 separate posts as of the blog’s birthday, not including all the additional pages that we have written. Of all these posts, I have authored 83 unique posts; 14 posts have been interesting questions posed by viewers/commenters in the Ask The Residency Director category; guest authors have written 8 posts.

Ten Most Popular Posts Written By Me:

Three Most Popular Ask The Residency Director Posts:

Three Most Popular Guest Author Posts:

Up To Date Book Reviews For The Core Examination by Danny Nahl, MD
Teleradiology, A Risky Business? by Haley Dezendorf
Has Technology Ruined Your Chance Of Employment In Radiology? by John Chung

Whirlwind Birthday Tour Of The Past Year

Not only did we have a prolific year at radsresident.com but we also were honored to have some of our posts published in some great blogs such as Aunt Minnie, Doximity, and PassiveIncomeMD!

Blogs Published In Aunt Minnie

Blogs Published In Doximity

Blog Published In PassiveInvestorMD

Alternate Careers And Supplemental Income For The Radiologist

Plus, we have survived one full website update and I have written a book called Radsresident: A Guidebook For The Radiology Applicant And Radiology Resident, both on Kindle and paperback. And, we have created new features that have been a great success such as Ask The Residency Director and The Case Of The Week. Of course, I am still experimenting and trying to figure out what interests you, the viewer, and what works on the website well so that I can continue to create interest, entertain, and grow the website audience!

Please Continue To Support The Website

Although our website is growing by leaps and bounds from its humble origins, radsresident.com continues to operate at loss. So, if you like this site, please continue to buy books and items through our affiliate Amazon.com in the books and links section.

Also, if you are interested in completing surveys for money, I am an affiliate of both M3 Global Research and GLG Group. I currently use both companies to complete surveys for extra cash. If interested, I highly recommend joining both organizations to maximize your survey dollars.

And finally, I am also an affiliate of grammarly.com. I use this application on a daily basis to help with correcting grammar for the website and find it exceedingly helpful. If you are interested in writing personal statements, papers, or other documents, I highly recommend utilizing it as a grammar check. Joining up is free for the basic version and you will also support the website. Just click the link in this paragraph.

The Future Of Radsresident.com

For now, I plan to continue to write lots of blogs that I hope will be useful and of interest to you, the reader. (I have 4 articles already written in advance and have lots of ideas for new articles!) In addition, recently, Doximity has asked to publish some of my new articles on its website. So, I am excited to announce that you can also expect that Doximity will highlight my articles in the Doximity op-ed section!

As we go along, I also hope to continue to get great questions from my readers to use for the Ask The Residency Director section of the blog. And, we will continue to publish interesting articles by guest authors as they come through. Of course, if you have any interest to participate in any of these ways, don’t hesitate to contact me at director1@radsresident.com!

Gradually, I also plan to experiment with what works best on this website. But, would be happy to entertain any further suggestions from you, the audience. Over the next year, you may notice changes to the website every once in a while as I add on concepts to the website that may be interesting or take away others that I find to be redundant or do not work as well. Please, I would love to know what you think! Thanks for celebrating the blog’s first birthday with me, everyone!

Posted on September 24, 2017March 2, 2022 by Barry Julius

Should Radiologists Ignore The Phone?

All told, on any given day as radiologists, we may receive tens of phone calls from our colleagues, technologists, fellow clinicians, administrators, friends, spouses, and patients. We are constantly bombarded with phone calls. So much so that I always wondered about the rate of interruption in a radiology practice. Well, I found one such paper. Confirming my suspicions, a study from Radiology Business(1) looked at 1000 minutes of radiologist observation and found that radiologists were interrupted 94 times or 2.4 minutes per interruption. That sounds about right! So, we are a specialty with lots of distractions.

Some of these distractions can be very important. Others not so much. Regardless, many of us feel obligated to pick up the phone to answer questions and resolve all sorts of issues. However, at what point does a phone call interfere with our concentration? Do these phone calls hamper our performance at the job? Should we always pick up the phone or just let it ring? Or, maybe is it worth our while to hire someone to pick up the phone for us? Let’s look at some of these issues and see if we can develop some suggestions for you, the radiologist or radiology resident, as we peruse the data.

Literature Review On Interruptions In The Workplace

Let’s start with the most general and go to the most specific. We know from multiple sources that distractions can severely hamper correct interpretations. Here are a few of those studies. The first study (2) looked at 54 students creating essays with a control group (no interruptions) and two experimental wings (interruptions during outlining or writing the paper). The authors found that writers reduced the word number and quality in the groups with interruptions.

Another article (3) looked at workers participating in a simulated submarine tracking program. In this study, the researchers interrupted the participants for 20 seconds with a blank screen. They found that the interruption significantly impacted situation awareness. These participants were significantly slower and less accurate in making decisions.

Next, let’s look at some healthcare studies. This point is where it gets even more relevant. An excellent review paper (4) looked at distractions in the healthcare environment. Two of the most pertinent studies discussed in the report included an article that found that drug dispensing errors increased by 3.42% with interruptions. Then, another article showed a relationship between surgical errors and the number of disruptions.

Most relevant to us, a paper referencing radiology residents looked at the error rate of reads. They correlated the error rate with the number of phone calls in any given hour. This study showed a correlation of an increased error rate of 12 percent with each additional phone call received on call. They concluded that telephone call interruptions might negatively impact on-call radiology resident accuracy (5).

Applicability To The Radiologist

So, how applicable is this information to us, the radiologists? Let’s take these studies to heart. We know based upon the literature above that distractions are not so great for essay writing, situational awareness, drug dispensing errors, surgical errors, and most importantly, film reading. These are activities that have a direct relationship to our daily work. I think, therefore, that these studies are directly applicable to our situation.

What Do We Do About The Phone Calls?

Now, this is the million-dollar question. We know that it is part of our job to take phone calls, interact with people, and deal with sticky situations amid our work. However, with this information in mind and the knowledge that interruptions cause problems, we as radiologists reasonably need to mitigate many distractions in the workplace. What does this mean?

Well, perhaps, we should have systems that allow other employees to field some of the administrative responsibilities. Radiologists should not be triaging phone calls. Administrators should ensure that only the appropriate phone calls get to the radiologist’s desk.

In addition, we need to be mindful of the impact of distractions on our work. And we need to make appropriate adjustments. If the phone is ringing off the hook and we don’t have administrators to take these phone calls, perhaps, we should not be trying to answer the phone when we are reading a case. Instead, we should answer the phone only when we have completed reading a study.

Summary

Based upon our whirlwind tour through the world of phone calls, distractions, and our work, we now know that phone calls are a significant issue in our workplace. Next time the phone rings, think twice before you answer it!

(1) http://www.radiologybusiness.com/topics/practice-management/quality/highly-disruptive-interruptions-cause-radiologists-lose-focus-reading-room

(2) http://journals.sagepub.com/doi/abs/10.1177/0018720814531786

(3) https://www.ncbi.nlm.nih.gov/pubmed/26314878

(4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3007093/

(5) Acad Radiol. 2014 Dec;21(12):1623-8. doi: 10.1016/j.acra.2014.08.001. Epub 2014 Oct 3

Posted on September 20, 2017February 24, 2022 by Barry Julius — 2 Comments

Ten Disastrous Consequences Of Poor Study Habits

Studying for radiology is intense and unlike anything that you have done before. If you think shirking your duties only hurts yourself, you are entirely and utterly wrong. For those of you that don’t yet get it but are willing to listen, here are 10 of some of the disastrous consequences of your poor study habits!

Harming The Patient

First and foremost, you took a Hippocratic oath at the end of medical school, right? Well, by not reading, that certainly goes out the window. Not studying well leaves you more prone to interpretation errors when reading films. Ultimately, this will affect patient care. Who needs unnecessary biopsies and increased morbidity/mortality? You don’t care about that!

Your Colleagues Don’t Take You Seriously

Notice that your colleagues never approach you for consultations on their cases and second opinions. You feel out of place. Why is that? If you read something, you would go over more interesting cases because your colleagues would have a good reason to talk to you. You may become a better film reader. Well, maybe you are not interested in films and consults?

You Go From Practice To Practice

You know this type of individual. Probably, you have seen an attending or two who do not last long at your program. Sometimes you are not quite sure why they left. But many times, they can’t interpret films well. Perhaps, if they had read and studied a bit more…

Can’t Pass The Core Examination

This statement cuts right to the heart of the first through 3rd-year radiology residents. What is a radiology resident’s worst nightmare? That they need to take the core examination twice. Why would you want to do that? Just study!!!

Difficulty Obtaining The Fellowship You Want

Your dream is to go into interventional radiology. Forget about it. You always wanted to do an MSK fellowship. No way. To get into the more competitive specialties, you need recommendations. Who will give you a good one when you have not read a lick and never attempted to change your study habits? Did you think about that?

Your Attending Dreads When You Are On Call

Have you noticed that sigh that seems to emanate from your attending’s mouth when you say you will be on call the night before his CT rotation? Well, you better get used to it! Who wants to be the attending of record after you make all those interpretation errors due to lack of reading?

No Job Connections

Finally, you graduate from your residency program. But, no one seems to let you know when that next great job is available. Why not? It is straightforward. Who would want to recommend you to a position when you don’t have the background to merit it?

Attendings Won’t Let You Perform Procedures

In interventional radiology, you realize that your colleagues are getting to do a whole lot more procedures independently than you get to complete. Why is that? Hmm… Maybe, no one trusts you to touch a patient because you haven’t read about the procedure at all!

Consults Walk By You

Have you ever noticed how any clinical physician that has a questi0n walks right by you to the other guy in the corner of the room? Well, you have established a reputation for yourself because you have not been studying the right way. You are no help to anybody. Maybe this is what you wanted- you now have less work. Congratulations!

Losing Out To The Competition

You are beginning to notice that your patient loads are dropping precipitously? Around the corner, another practice opened up that now reads studies that you don’t feel comfortable reading because you are unwilling to study and learn about the new image modalities in radiology. Your wallet begins to suffer!

Bottom Line For Poor Study Habits

Reading, studying, and continually learning are all part of becoming a great image interpreter. A radiologist cannot exist in today’s climate without these tools as a resident and beyond. Why would you want to destroy your reputation and have to deal with the ten disastrous consequences of poor studying habits!!!