Month: May 2018

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Transparency And The ABR: Are The Leaders As Transparent As They Like To Think?

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At the recent Association of University Radiologists (AUR) meeting, the American Board of Radiology (ABR) adopted the theme of transparency in its lectures. However, as I sat and listened to the seminar on the ABR updates, the words did not jibe well with the theme.

How The ABR Supported Its New Found Transparency

Brent Wagner, MD, the President-Elect of the organization, attempted to show as a nonprofit entity, the books are wide open. And that, the money that they raise from testing fees and MOC mostly goes to the upkeep of the organization. In fact, they showed the public income tax form they filed with the IRS. In it, he stated that anyone could pretty much look up the finances of the organization and its members. So, I pulled up a copy of the nonprofit 990 IRS form for the 2016 tax year at the following link:  http://990s.foundationcenter.org/990_pdf_archive/410/410773787/410773787_201703_990O.pdf

Yes, much of the money does go to the running maintenance of certification, testing, and other appropriate uses. But, that is not all. If you look at the form, you will see listed the compensation for the executive board listed on page 7. According to the document, compensation for the president was 720,000 dollars for 50 hours of weekly work. In addition, the ABR paid the associate executive directors on the list who worked 20 hours over 260,00o dollars including all compensation. Of course, this compensation does not include any other outside remuneration that these individuals may receive from outside practices and institutions. So, if you take all the income into consideration, it is significantly more than the typical radiologist’s. But yes, it was available for all to see.

My Issues With ABR Executive Compensation

So, what is that did not sit well with me about the executive compensation? For one, you have an army of volunteers that the ABR does not pay for all their time and effort. Meanwhile, you have a small group at the top who collect significant rewards. Yes, this is a nonprofit organization and the folks that run it should get paid for its work. However, at the top, these folks earn a lot more than a typical radiologist. When I pay my annual dues, I don’t believe there is much value in paying a president of this organization over 700,000 dollars not including additional outside compensation that she may receive.

I mean, what exactly is the point of the organization? Simply, the ABR should dedicate itself to the high standards of the end product of residency, the radiologist. Additionally, the organization should make sure that it’s diplomates meet the minimum requirements to practice radiology safely while maintaining a relationship with the public and government. Should the leader at the top earn almost twice the average radiologist for this mission (not including other side income)? It’s certainly hard for me to justify.

And just because the organization exists as a nonprofit entity and must distribute all profits by the end of the year does not mean that the nonprofit model is fair. A nonprofit is only as good as its ability to distribute its funds appropriately for the betterment of a cause. Rewarding the executives with salaries above and beyond the typical radiologist does not qualify as a cause I want to support.

Moreover, finally, in order to justify the salaries it paid to its executives, the speaker compared itself to other nonprofit organizations. However, just because other nonprofit entities overpay its executives does not mean that the ABR should do so as well.

My Final Thoughts About ABR Transparency

Alright, I will give the ABR some points for coming clean with the whereabouts of its funding. And, I will give them some credit for talking about the remuneration of its members. As well, they gave us the means to access the information. On the other hand, the ABR is not forthcoming with providing the reasons for the exorbitant compensation of its leaders. We should advocate for more transparency and demand more from the ABR. Creating more equitable compensation to its employees and leaders should take a higher priority.

 

 

 

 

 

 

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Clinician Interruptions In The Reading Room: A Necessary Evil Or An Avoidable Interaction?

clinician interruptions

For those of you that practice radiology, how often do clinicians interrupt you on a busy rotation? And, what percentage of the time does the clinician provide helpful information without interrupting your train of thought? I know I can only speak for myself, but many clinical interactions prevent me from completing my work, increase my inattention, and should probably occur at another time. How often does a clinician stop by to ask you when you will finish his patient’s report only to lengthen the time to complete the dictation? Assuming my experience is similar to others, I believe those clinician interruptions can overwhelm many positive daily interactions.

 Plus, based on the evidence (check out Should Radiologists Ignore The Phone?), we know that interruptions cause an increase in error rate with our reads. So, therefore, clinician interruptions become much more than an issue of mere convenience. Instead, we need to take clinician interruptions very seriously. To cover this longstanding theme, we will discuss whether clinicians and providers should be allowed to enter the radiology reading room. Then, we will talk about potential solutions to these problems. So, let’s begin!

Reasons To Allow Clinicians To Enter The Reading Room

Knowing that interruptions prevent us from reading cases to the best of our ability, one could make a case that we should nail our reading room doors shut. But fortunately (or unfortunately!), this cannot happen in reality. Moreover, it probably is not such a good idea.

So, what are some legitimate situations when a clinician in the room may enhance the reading of our cases? Well, first of all, we must welcome all good histories that help us to make a diagnosis. A clinician coming into the room with this message can become a lifesaver, literally. The clinician can change the diagnosis and management.

Second, a clinician in the room can help when we need to relay an urgent message. For instance, perhaps you find an impending aortic rupture and need to get in touch with the vascular surgeon. Wouldn’t it be nice if the physician just happened to be standing next to you instead of calling all over the hospital to find him?

And then, sometimes, a clinician can enhance our reads when we are unsure of the best way to manage the patient. For instance, maybe, you recommend an MRI, but unknowingly the patient already has a pacemaker. Yet, if a knowledgeable clinician stood next to you, you would ensure that the patient had received some other test, such as a gallium scan.

Clinician Interactions That You Should Prevent

As I discussed above, clinicians should not ask the radiologist when he will complete the study. An assistant or secretary should handle these requests. Furthermore, the technologist or clinician should mark a study as STAT, priority, or routine. And the radiologists should dictate these cases in an appropriate order from most emergent to least. For this reason, a clinician stopping by the reading room interrupts the workflow and is redundant.

In addition, as much as I like medicine rounds from an educational point of view, having a team of medical physicians interrupting the radiology workflow on initial patient reads does not contribute to good patient care. Educational rounds during live readouts can disrupt search patterns and often warrant inefficient rereads of the same films. Furthermore, these types of interactions can cause other errors. On the other hand, educational rounds at a specified time after the radiologist made the reading would not detract from patient care.

Finally, as much as I like a suitable, quality, friendly conversation, clinicians should not use the reading room as a place for small talk. These sorts of conversations can also act as a nidus for errors!

What Are Some Potential Solutions To Allow Useful Clinical Interactions While Mitigating Interruptions?

Unfortunately, the task is not easy. But here are some logical recommendations:

First of all, having a “1st line triage” can help the process of selecting who can enter the reading room. Like other professionals with secretaries and assistants, radiologists should also have clinical assistants who can manage interactions with our colleagues. Radiology assistants can serve this function. (a more expensive option) Alternatively, junior residents may also help to prevent unwarranted interaction. Rather than interrupting the clinician workflow, the junior resident can field the questions and may interact appropriately with the physician. The junior resident can also learn about clinical medicine from the interaction.

Second, make sure to make it understood that the reading room should exist as a place for reading films and not unwarranted conversations. The placement of signs and a general culture of using the reading room as a workplace can prevent some of these disruptions.

Finally, we should proactively inform and train our clinical colleagues regarding the appropriate questions and times to enter a reading room. Continuing education via interdisciplinary conferences and general interactions can undoubtedly help.

Final Thoughts About Clinician Interruptions In The Reading Room

Clinical interruptions are more than just a nuisance. Instead, they directly impact workflow and increase the error rates of the interpreting radiologist. Therefore, hospitals and imaging centers should create appropriate reading environments for beneficial clinical interactions with radiologists. At the same time, they should create an environment that avoids significant clinician interruptions. Hiring more staff, using residents appropriately to triage, and creating quiet reading rooms can allow uninterrupted workflow. So, next time you are interrupted, be proactive and do not allow these interactions to continue. Politely ask the offending clinician to wait until you complete the reading. And then consider discussing the issue with your residency or hospital. Working to improve the efficiency and quality of clinical interactions can save lives!

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What Really Goes On At A Radiology Practice Partners’ Meeting?

partners' meeting

I can remember back during my radiology residency many years ago. Every so often, the radiologists at my hospital would meet secretly outside the hospital for their partners’ meetings. As the radiology attendings rapidly left to abandon their shifts to get to this meeting, I thought perhaps the partnership was just like the secret societies such as the Freemasons or the Illuminati. Maybe, they had a secret handshake? Or could they be plotting the overthrow of the hospital or government? What was going on at the partners’ meeting?

Most likely, you also wonder what happens during the partners’ meeting since you have never experienced anything like it. Moreover, you are an outsider, not privy to private practice business. Yet, one day many of you will also become a partner in a radiology practice. So, today I will reveal the secrets behind what partners discuss at their business meetings. Therefore, pull up a chair, read this post, sit back, drink, relax, and enjoy. Now, you will learn the truth behind what the partners discuss at a partners’ meeting!

Finances

As you might expect, at most meetings, a business manager often discusses the current state of a practice’s finances. Are reimbursements declining? Do new potential sources of revenue exist? What imaging modalities are trending higher? Should the business renegotiate insurance contracts? For some of you, your eyes may glaze over when you hear about a practice’s finances. However, these discussions are essential for continuing business as usual. And, yes, radiology is not just about health care. It also needs to run positive income to pay the employees, the fixed costs, the partners’ salaries, that end-of-the-year Christmas party, and more. Most meetings involve financial discussions.

Long-Term Strategies- Mergers, Acquisitions, And Partnerships

Nowadays, practice size has trended upward. Many practices must evolve to create larger entities so that they can use economies of scale to reduce costs and maximize profits. What do I mean by that? Essentially, practices can distribute fixed costs among a larger group of employees, thus saving money for the business. Therefore, you probably hear a lot about practices merging or private equity firms buying out imaging companies to save on costs. Well, partner meetings are common private forums for discussing these issues. In addition, you can expect practices to talk about ways to maintain good relationships with the hospitals and clinical colleagues as a long-term strategy. This long-term strategizing all happens at some partners’ meetings.

Manpower Issues/ Human Resources

Almost every practice has its fair share of issues with employees. Perhaps, some physicians do not meet the requirements of the hospital. Or maybe, clinicians have been complaining about certain practice members. Partners meetings are the appropriate forums to discuss these practice problems. In addition, partners discuss hiring new employees to meet the demands of the practice. Partners will discuss these problems and attempt to devise solutions to match the workforce to the practice’s needs.

Scheduling

One thing that is constant in any practice is change! Whether it be new imaging modalities, increasing requirements of films to be read, or losing business to other clinicians, the scheduling demands must meet the appropriate workloads. Partnerships will broach better ways to schedule partners and employees to maintain maximal efficiency. In this same vein, practices will also debate vacation policy schedules and the appropriate workloads for daily and weekly rotations whose needs may differ over time. These items commonly enter into the typical partners’ meeting.

Beauracracy and Compliance Issues

Every year, governments develop new rules and regulations for practices to follow. A few years ago, it was ICD-10 codes. Now we have new quality improvement mandates set by Medicare. Whether for certification maintenance or hospital credentialing bylaws, these items constantly change and can be crucial for maintaining the practice and complying with the law. All partners need to keep aware of the newest compliance issues to run an imaging business successfully. What better forum than a partner’s meeting to discuss this?

Insurance And Benefits

In this category, I will include malpractice, health, life, and disability insurance, pension plans, and yearly bonuses. Partners must approve the renewal and disbandment of these annual benefits. These changes depend on the costs and overall contribution to the practice and partners. You wonder how they come up with these policies. Well, usually, this occurs at the partnership meeting!

Residency Issues

Lastly, although residency issues crop up, that can affect the practice. If you have an imaging company with a residency, the partners may or may not discuss it in a partnership meeting. But, they occasionally make it to the partners’ meeting agenda. The discussion could be about new residency requirements, a site visit from the ACGME that all partners need to plan for, a specific resident issue, a problem resident, and more.

The Secret Partners’ Meeting- Final Thoughts

A partners’ meeting is a necessary evil to maintain a practice. And, as you can see, a partners’ meeting agenda can fill up quickly. Depending on the time of year and the number of issues, meetings can take hours and hours. Yet, the partners’ meeting is an essential aspect of a quality partnership and business. So, the next time you see the partners disappearing to attend the partners’ meeting, you now have some faint idea of what happens. Although you may never learn the secret handshake (or the nitty-gritty financial details), you now know what to expect from that occult partners’ meeting. And no, it’s most likely not just about discussing you!

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Top 10 Resident Issues That Radiology Faculty Wants You To Know But Can’t Say

Top 10 Resident Issues

Most radiology attendings want their residents to succeed. However, etiquette rules cause many to withhold their feedback about some of the resident issues that they encounter on a daily, weekly, or monthly basis. Unfortunately, for that reason, they keep many of you in the dark. However, please learn from their mistakes and enlighten you all. So, to prevent you from continuing with these resident issues, I thought I would create a top 10 list that the faculty wants you to know but may not say… Here we go!!!

You’re Too Aggressive

Are you overcalling everything or coming down hard on a final diagnosis without any other differential? Are you accustomed to the surgical mentality? No longer can you just nod in agreement, but you push, push, push? Everything is an argument. And, your attending does not have the time to talk back. Gosh darn it, perhaps you are more aggressive than you should be at this stage of the game!

He Misses Everything

When your attending sees that you are missing all the findings during the night, he may not feel so great telling you about all these errors. How will that help anything? And I mean, he doesn’t want you to feel bad about it when he tells you, does he? Unfortunately, you may miss out on some of these learning experiences. But, your attending may not let you know!

She Has Poor Hygiene

Poor hygiene can be just plain embarrassing. But, sometimes, your faculty may become very uncomfortable dealing with malodors or unkempt appearance. It often needs to be said to the resident but doesn’t. And, all the other faculty and residents suffer from this resident’s poor hygiene!

You Just Don’t Listen

The attending keeps on telling the same resident the same old thing. But, time after time, nothing changes. No longer can the attending tell you what to do anymore because it does not seem to work? So, your attending does not bother you anymore. What’s the point of hurting your feelings?

He’s Way Too Enthusiastic

Don’t get me wrong, but it is great to be enthusiastic. And, your attending certainly does want you to become excited about radiology. But, too much of anything is no good. And sometimes too much enthusiasm can be a bit too much. It can wear on your techs, nurses, and attendings. So, temper that enthusiasm just a bit!

You’re Just Plain Dumb

Often, your attending will ask you questions to see if you have been reading enough. And it is OK to get some things wrong. However, on occasion, a resident does not know anything that he should. Is your attending going to tell you that, maybe or maybe not? Who wants to say to the resident that she is just plain dumb?

She’s Getting A Bit Too Chummy For My Liking

On occasion, our residents can become a little too familiar with us if you catch my drift. It can all be a little too “touchy-feely.” So, think about how you communicate with your attending. Is it appropriate? Or are you trying too hard to become his best friend?

He Wants Always To Be Spoon Fed

Most residents want to learn from their attendings. Some residents expect all the learning to come from their attendings with no work on their part. If you desire to breed ill-will, you can do just that. Don’t help out your attending. Instead, just expect them to teach. It can be very irritating!

You’re Always Abandoning Ship When The Work Is Not Done

Excuses, excuses, excuses… You have to get to a wedding. Or, maybe you need to go on a date with that new beau. Well, your attending does not want to be the one to break it to you. He does not want to be the unfeeling guy that ruins the resident’s time. But, is it right that you are always missing all that work?

He’s Preventing Me From Getting Anything Done

Some residents like to talk a lot. And, most attendings like a good conversation as well. But, sometimes, it can interfere with the daily work that needs to get completed. How can your attending break it to you when she likes you a lot. Well, it can be challenging at times!

Final Thoughts About Resident Issues That Faculty Want You To Know But Can’t Say

Rightfully or wrongfully so, many taboos exist that prevent faculty from telling you, the radiology resident, what is going on. And even though attendings are supposed to evaluate and give direct constructive criticism and feedback, that is not the reality of the situation. So, if you think that you may have one of these ten resident issues listed above, try to change it on your own because you may never get the real story!

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AUR Meeting 2018- Themes And Undercurrents

Welcome to the second annual review of the Association Of University Radiologists meeting in 2018! So, why do I think we should review this meeting on an annual basis? Well, for one, many of the changes in residency you will experience stem from the academic realm.

Moreover, if you were to read the headlines and the summary of the lecture topics of the conference alone you would not get a good sense of what they will be changing. For example, this year, the heading of the meeting states “Health And Well-Being Of Profession And The Professional”. However, this theme is a small part of what actually happened at the meeting.

Yes, the lecturers did cover the topics of burnout and depression, relevant to the heading. But, if you dig a little bit deeper, compared to these themes, you would recognize that many other themes will impact future residents much more. So, what are the undercurrents that were most relevant? Basically, I am going to divide these topics as follows: continued improvement of the job market, increasing radiology residency match competition, the online longitudinal assessment, Radexam, and increasing time requirements for program directors.

The Hot Improving Radiology Job Market

Out of all the news, I think this is probably the most important. Based upon the hot topics lecture series at the AUR meeting, radiology has climbed out of its doldrums and now returns to a more normal job market. In the most recent year, over 1800 positions were available for new graduates. Very recently, the number of new hires amounted to the low 1100-1300. Furthermore, according to the conference, next year they predict that practices will need 2133 new hires. So, workforce demands are significantly increasing. My reasoning for the sudden increase in available jobs: a wave of retirements and willingness of practices to hire due to stable/good economic conditions. So, congratulations to all residents who chose radiology over the past 4-5 years! You can look forward to a great job market.

Continued Increasing Competitiveness Of Diagnostic Radiology Residency

Similar to the previous year, the competitiveness of radiology residency in the match continues to increase. As in the previous year, the unfilled spots continues to decrease and the percentage of US grads entering radiology residency continues to increase. All of these signs point to a much more difficult time for the US and foreign grads to match in radiology.

Online Longitudinal Assessment Replacing 10 Year Exam

Yes, I know that many of you have not yet thought about the maintenance of certification requirements once you have completed your residency. However, this new program will impact all residents today once you graduate and become board certified. No longer will ABR diplomates need to take an exam every 10 years to maintain certification (unless you do not satisfy the requirements of the new program). Rather, everyone who takes the online assessment will be able to skip the test and simply answer weekly questions that you receive via email.

Each year you will receive 104 question opportunities and you can choose to answer as few as 52 per year. You need to pass the scoring performance criteria based on 200 questions every 4 years. Fortunately, this system will replace the time sink of having to attend a test in Chicago every 10 years with all its expenses. I am certainly looking forward to bagging my unnecessary trip to Chicago for the recertification examination!

Radexam Now Operational

For residency programs throughout the country, many have implemented the new Radexam, replacing the old in-service examination. From my experience, the old in-service examination served a futile role in evaluating residents over the 4 years of residency. I believe no correlation existed between the passage of the core examination and the in-service exam. Now, this fact may change. The new Radexam crowdsources questions from numerous question writers throughout the country. And, the questions are vetted and evaluated for validity. In addition, the exam tests residents according to individual residency level. They can be used at the end of a rotation. Eventually, the exams can be tailored toward the types of rotations the radiology residency has (modality or organ based). I look forward to evaluating the quality of this new exam. More importantly, I believe it has the potential to revolutionize evaluation of residents, especially at smaller programs.

Increased Mandated Program Director Time Requirements Officially Implemented Starting July 1, 2018

Especially at the smaller programs like ours, the new ACGME rules about program director minimum time requirements will create an enormous impact on the management of residency programs throughout the country. Check out this webpage from the ACGME and the associated chart below:

https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/420_DiagnosticRadiology_2018-07-01.pdf?ver=2017-08-10-081454-583

0.3 full-time equivalent (FTE) for programs approved for eight to 15 residents; (Core)
0.4 FTE for programs approved for 16 to 23 residents; (Core)
0.5 FTE for programs approved for 24 to 31 residents; (Core)
0.6 FTE for programs approved for 32 to 39 residents; (Core)
0.7 FTE for programs approved for 40 to 47 residents; (Core)
0.8 FTE for programs approved for 48 to 55 residents; (Core)
0.9 FTE for programs approved for 56 to 63 residents; (Core)
1.0 FTE for programs approved for 64 to 71 residents; (Core)
1.1 FTE for programs approved for 72 or more residents. (Core)

 

Basically, the minimum required time for program directors to administrate programs has in many cases doubled. At our program, we are going from a 0.2 Full-Time Equivalent (FTE) (one day of administration time per week) to a 0.4 FTE (two days of administration time per week). As many programs have suffered from lack of administration time for programs directors, this change should enhance the quality of many radiology residencies. Some manpower/administrative issues that remained unresolved in radiology residencies can now be tackled due to decreased time pressures.

Final Thoughts About The AUR Meeting

Unlike previous meetings over the past four or five years, most of the doom and gloom has passed. Ironically, although the headline lectures were about depression and burnout, the mood was much more upbeat for new and graduating residents. Between the rising job market and the stable economy, the new MOC, increased program director time requirements, and the new Radexam, things are looking up. Even the wave of concerns about artificial intelligence replacing radiologist has seemed to pass us by! (No one believes that it will replace radiologists any time soon).  So, for all radiology residents, you are entering the field at a great time. And, this meeting certainly confirmed my suspicions!

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A Ridiculous Error In The Radiology Report: Can I Recover My Dignity?

error

At some point in our careers, we all make ridiculous report errors. In fact, I know several radiologists that collect and sort several of these “oopsies” in the hopes that one day they will create the book of their dreams. However, some of these mistakes can feel embarrassing if you are the radiologist writing the report. Worse than that, sometimes your referring clinician or patient will call you on it. It could be a simple error like an obscene typo. (the substitution of the word “fecal” for “fetus”!) Or, it could be a detail you would have never thought to mention but your clinician wanted to know. (He asked to rule out sphenoid sinus disease, and you forgot to mention the sphenoid!) Ultimately, these mistakes go on record for all the patients and clinicians. So, how do you deal with these unfortunate miscalculations? And what do you tell the clinician? As you can tell, we will answer these questions as we dedicate this post to the delicate unforeseen “oopsie” and subsequent attempt to recover your dignity!

The Three-Step Process When You Make An Error

Make A Quick Addendum

First off, luckily, you have discovered the error in the report. Perhaps, you read the old dictation or received a phone call from the secretary. Unfortunately, however, you often make the discovery a long time after signing it off. So, what do you do? Issue an addendum as soon as possible! In most clinical practices, addendums from voice recognition technology software typically get faxed to the clinician, just like the initial report. In this situation, the clinician will receive the addendum with the rest of the dictations for the day.

Guide The Doctor To The Correct Report And Follow-Up

However, issuing an addendum is not enough. Often, the clinician will not expect the fax you give as an addendum. Bottom line: it might not get read. And sometimes, the undiscovered “oopsie” may lead to inadequate follow-up, insurance problems, patient anger, or other subsequent clinical issues. Therefore, the rules of mutual respect obligate you to contact your referring physician directly by phone or in person, if possible. It’s a horrible phone call, but you must close the loop.

Profusely Apologize For The Error

Although a touchy subject, I would recommend apologizing to the clinician (or patient if necessary) for the error. More importantly, let the receiver of the error know that you have made amends by changing the report and following up with the report recommendations. Most clinicians will appreciate your effort to correct the issue with the dictation.

Can You Recover Your Dignity From An Error?

Unfortunately, I can’t give you a better answer than it depends. For ages, some may refer to you as the clinician who added a ridiculous mistake to their patient’s report, potentially giving you an unwarranted reputation. On the other hand, others will realize that you made the error as a “one-off” and will quickly forget. Regardless, we need to negotiate these pitfalls as the hazards of our profession. And most importantly, we are more likely to garner respect from our colleagues by dealing with the consequences of the “oopsie” head-on rather than lurking in the shadows, hoping the error will go away one day. So, don’t just ignore the error, so you don’t draw its attention. Instead, own your mistakes before they own you!

 

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Residency Travel For Presentations: What Are The Steps Involved?

travel

Congratulations!!! The Radiology Society of North America (RSNA) has accepted your poster for presentation at the convention. Or perhaps, the Association of University Radiologists (AUR) has chosen you to make a presentation at the next meeting. When and how do you prepare for the trip? What are the best travel arrangements? How and when do you make your plane flight? I plan to answer these questions and more to make your next trip that much easier!

Notify The Program Coordinator First

Most importantly, before booking the event, ensure that your program coordinator knows first. Why? If you forget to do this, you may find the hospital will reimburse you less than you think. Or, perhaps, the program will not cover certain parts of the trip. The program coordinator also has precious information on how to submit expenses for your trip. You must submit your receipts at many programs first and then get your money back later. In other programs, they may cover your expenses upfront. This information is critical, and your coordinator usually has the answers!

Book The Hotel Next

Booking a hotel is usually the rate-limiting step for residency travel for presentations. Why do I say that? Hotels tend to book up first before the plane, the meeting, etc. Over the past few years, I have known several residents who could not reserve a spot in their first-choice hotel because it was already entirely booked. So, you should check your meeting website before booking. Often, you will find group discounts for hotel stays.

Some other tidbits for booking your hotel: First, stay as close to the conference as possible. You don’t want to worry about damaging your poster or arriving late to the event on the day of your presentation. And you certainly don’t want to get stuck in a downpour! Also, make sure to review the hotel for your needs before booking. So, if you are taking your family, ensure they have the correct size room, etc. Finally, before booking a hotel, also join the hotel club so that you can receive points for rewards for the next time you travel.

Make The Flight Arrangements

Over the years, I have found that it is best to book a direct flight if possible. Worrying about connecting flights can be extremely unsettling. Sometimes, the plane arrives at its destination too late, and then you miss the next connecting flight. The last thing you want to do is arrive late for your conference! It is generally safer and less time-consuming to fly one direct flight instead of many legs. It is not worth the minimal savings.

If you are interested in flying as economically as possible, I recommend several possibilities. You can sign up for multiple price alerts from different airlines. Also, some websites let you know when the airlines have the best deal. These include sites like Hopper and Hipmunk. One article also advised following #airfare #flights on Twitter to get you the best deals. Check out the following article that I thought was extremely helpful: http://www.chicago tribune.com/lifestyples/travel/ct-best-time-to-book-airfare-20170614-story,amp.html

Finally, if you have not done so already, it makes sense to sign up for frequent flier miles at the airline you choose. Most likely, you will fly again and again. So, you may as well try to benefit as much as possible! Also, some credit cards accumulate frequent flier miles and give extra benefits such as free baggage check-in.

Sign Up For The Meeting

Regarding signing up for the event, most meetings for radiology do not fill to the maximum. So, you do have a bit of time. But be careful. Some conferences have early bird specials and discount early bookings. Therefore, don’t perseverate too much. Also, make sure you book the event under the heading of a resident. At some meetings, residents get a discounted rate!

Think About Local Transportation To the Gig

Now, this part gets a little complicated. For most of you, taking a shuttle to the hotel is the most cost-effective and straightforward. However, others may arrive with family members and plan to travel to other sites at the meeting destination. Or, maybe you want to travel a bit near the meeting after your presentation. In that case, consider renting a car. (It’s usually a bit more expensive!) Otherwise, if you want to get in and out of the meeting quickly, stick to using shuttles or sharing a taxi with friends to save a few bucks.

Keep Your Poster/Presentation Safe

Treat your presentation like gold! Make sure it is safely ensconced in a cardboard roll if it is a poster. Or make sure you protect your flash drive well if you need to present. I would recommend having a backup if possible. The last thing you want to do- is to notice you have a broken flash drive when you are about to present your topic!

Don’t Freak Out!

All that hard work has amounted to getting to this point. So, you will do great. Practice your presentation a few times in your room if you think you may be a bit rusty. These few days, you should be enjoying the fruits of your labor, not worrying about your presentation.

Enjoy Your Travel Destination!

OK. You have traveled to such a great destination. Why not try to take advantage of the site? Plan some activities. Try some great restaurants. Tour the area if you can. Have some fun! Who knows if you will get a chance to return soon? Congratulations!

 

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Urgent Case And I Can’t Get In Touch With The Doctor: What Do I Do?

urgent case

Covering physicians should always be available, especially in an urgent case. However, when you begin radiology practice, you will find that 24-hour physician availability is a pipe dream. Once in a while, I encounter situations when I cannot reach a physician, let alone a nurse. Fortunately, most of the time, if I wait a day or two to contact the physician, no harm will come to the patient.

But then, now and again, we read an urgent case that can potentially represent the difference between life and death. Perhaps, you find a spontaneous pneumothorax in a patient with mild chest pain. Or, maybe you see an impending aortic rupture in a patient with heartburn. Regardless, good medicine and the law dictate that we must communicate these urgent results rapidly so the patient can get appropriately treated.

So, what do you do when you cannot get in touch with a physician and have an urgent case? Do you yell down the hallway? Do you stomp your feet? Or do you send smoke signals via the hospital generator? You can do any of these fun activities if you want to. (Sure would release a lot of stress!) But, today, I will go into more effective ways of ensuring that the patient receives the appropriate care when you cannot reach the covering physician. To introduce this topic, I will give you a few real-world scenarios and instruct you on what my colleagues and I would have done.

Call The Patient Or Patient’s Caretaker Directly

These are the sorts of cases that tend to occur at the very end of the day. The last episode I remember happened when I looked at the previous outpatient case of the day at one of our imaging centers. I recall looking at the final abdominal CT scan at about 8:30 PM on a late shift and seeing oral contrast density framing several bowel loops on a CT scan. Then suddenly, the anticipation of going home shifted to dread. I knew I would be lucky if I could reach anyone to let them know this patient had a bowel perforation. And, right, I was…

As expected, I called the physician covering the patient multiple times. But to no avail. All I got back was a ringing telephone. What would you do next? Well, I did the most logical thing. , I called the patient’s house and reached the wife of the patient. I told them to get checked out at the local emergency department immediately.

Fortunately for the patient, everything turned out alright. But, if I had continued to call and wait for a physician to pick up, the patient could have died. Sometimes, you have to contact the patient directly!

Send A Certified Letter

Other times, you may make a significant finding but not quite as urgent. Maybe, you discovered cancer on a mammogram. Again, you try to reach the covering physician. But, it does not work out all too well. At this point, you still need to make sure you directly contact a covering physician or patient. Otherwise, you can be liable if the patient did not follow the appropriate treatment. But you also have another option if you can’t get in touch with the physician or patient. You can send a certified letter to the address on record.

Certified letters indicate that you have made a reasonable effort to reach the patient after the initial communication failed. At least, you can make sure you have performed your due diligence.

Call The Cops/Dial 911

In other situations, the consequences of not getting to the patient in time can be dire. Let’s say you detected a subarachnoid hemorrhage on an outpatient at 9 PM in an imaging facility, but the imaging center completed the case in the early afternoon. And, again, you cannot get through to the doctor or patient. One radical technique to overcome this issue is: Call the police and dial 911. Theoretically, if you suspect that the patient may be at risk of life or limb, the police have the authority to knock down the door and ensure that the patient receives appropriate care. Fortunately for me, I have never had to resort to this option. But I know of other radiologists who have.

Final Thoughts About Communicating An Urgent Case When The Doctor Is Not Available

Usually, when you have the will to get through to a covering physician or patient, there is a way. Sometimes, you need to take more extreme tactics into your own hands. Remember… It’s for quality patient care. So, don’t give up. Instead, make sure to follow through. Because otherwise, you risk not only the patient’s well-being but your career as well!

 

 

 

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About To Start Radiology Residency-What Should I Do To Prepare?

prepare

Here are some scenarios: You’re about to finish medical school, and you’ve matched in radiology.  Or, you are in the middle of your internship year, and you have begun to ponder your next year. If you find yourself in either of these situations, you most likely receive mixed messages on whether or not to prepare for your first year. Some of your “mentors” have probably relayed to you how they readied (if they did anything) for their first year of radiology.

When you hear some of these stories, many of those folks have some hidden motivations. Perhaps, they want to appear like they know it all. Or maybe, they want to make it seem like their decision was the right one. (Even though it may not have been) So, please listen to me. Having seen many incoming waves of medical students and residents coming through the department, I will give you the real lowdown. Here’s what you need to know when you start.

Should You Read Anything Radiology Related Before Starting Radiology Residency?

The short answer is yes. But, of course, I will go into a little bit more detail than that!

So, what do you need to know before beginning? For everyone, if nothing else, I would recommend that you at least relearn basic anatomy. Why is that? Since it is difficult to know what you need to learn in radiology when you have not entered into the field yet and radiology is so “anatomy intensive,” you are better off starting by reinforcing the general anatomy that you learned in medical school. For general anatomy, an anatomy book like Netter that you used during medical school will help you to recall the basics.

However, instead of learning anatomy the same way as your medical school course, I would take more of a cross-sectional anatomy approach. To do so, make sure to find a decent cross-sectional anatomy book to supplement Netter. Not only can you use it to learn cross-sectional anatomy, but this book would also be an invaluable reference source during residency and beyond. Even now, as an “old-timer,” I often use the Atlas of Human Cross-Sectional Anatomy: With CT and MR Images whenever I need a reference. A book such as this almost “pays for itself.”

Why is it so important to have a cross-sectional anatomy book to study? Well, that is how most of us radiologists interpret images. You need to know the anatomy to catch the pathology. So, when you begin, you will have the tools to learn the basics of radiology rapidly (since we are an anatomy intensive specialty!). If you prepare your cross-sectional anatomy before arrival, you will have a certain headstart over your colleagues.

How To Go About Additional Radiology Reading Before Starting Radiology

Fourth Year Medical Students

Since fourth-year medical students typically have a bit more time on their hands, what material would I recommend if you want to learn more than just cross-sectional anatomy? First, you can review the essential medical student texts like Learning Radiology. These sorts of books tend to contain the most basic information like how to read chest films, and so on. Also, they will review the essentials of the primary radiological modalities that you need to know.  However, these texts will not go into enough detail to make you stand out.

But, if you are even more motivated, consider looking at the pictures and captions in a book like Brant and Helms. Then, you can review the subtext to reinforce the images. But beware! It is a long series. And, believe or not, even though it is long, it does not cover enough of the information you need to know to prepare. Most importantly, however, do not get discouraged if you cannot complete it. Any bit that you accomplish before starting residency helps.

Interns

OK. For interns, the first step is to make it through the year. You are probably going to be exhausted and lucky to pick up anything additional to read. So, I would probably stick with reviewing some basic cross-sectional anatomy at this point. In general, lack of time will prevent you from reading through a Brant and Helms type of book. But, if you feel you must go for it, by all means, try to read a little bit. Just don’t push it!

Final Advice On How To Prepare For The Beginning of Radiology Residency

Finally, my last bit of wisdom for the pre-radiology resident is that what you are doing now is very different from your radiology career! So, don’t wrap yourself up in the miseries of your clinical year. Remember… Your life will be very different from your medical colleagues. So, soldier forth, read a little bit if you can, and before you know it, the year will be over. Follow my advice, and you’ll grasp what you need to prepare to start your radiology residency!

 

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