Round, round, get around, don’t skip around. Reminds me a bit of the Beach Boys tune I Get Around. Regardless of the weak attention-grabbing first sentence, I think this advice is vital for the radiologist. And it applies to us in many ways. First and foremost, it helps to ensure that you are covering all the findings. But, it is far more than this. Keeping reads in order without skipping around also will enable you to triage appropriately, allows you not to piss off your colleagues, and most critically, ensures that you don’t forget the reason for reading a study. So, let’s delve a little bit more behind each of the reasons behind the nitty-gritty of this philosophy.
Covering All The Findings
What is the best way to make your dictations less accurate? Well, have as many interruptions as possible! And what is it about these interruptions that cause missed findings? Typically, most radiologists will forget what they were doing before.
Since it is impossible to prevent all interruptions (although you can mitigate them), you can avoid loss of sensitivity by sticking to a routine without skipping around. So, the next time the surgeon barges into the room with a question while you are dictating, you will know exactly where to return your focus when the interruption ends. If you repeat a similar routine without skipping around, you will rarely lose your place for long!
What is it about skipping around through a list of patients that can cause triage issues? Well, it’s not fair to read a study first on a patient with similar urgency to others when he was the most recent one completed, right? How would you like it if someone cut in front of you in line at a supermarket? It’s the same philosophy.
But more critically, you should be reading the tech flagged positive findings first, the “STATS” second, the expedites third, and the routines last. Subverting this order can cause clinical disasters, potentially delaying reads on patients with positive results. Why would you want to read a routine oncology workup before a possible intracranial bleed after trauma? Finding a lung nodule is not equivalent to discovering an epidural hemorrhage. Triage in order and don’t skip around!
Order Among The Rank And File
When all members of a practice are working hard, they don’t want to worry about radiologists that are cherry-picking the most straightforward cases to spruce up their RVU numbers. How can a practice avoid such an issue? Well, have the readers read studies in order of when they were performed. Practices often perceive those members that skip around to be skirting the rules. So, sticking to the list order can help morale!
Circling Back To The Impression
And then finally, to come up with an appropriate impression in any case you read, you should never jump to it without analyzing all the findings first. Skipping around and getting to the conclusion right away is a formula for disaster. Think of it like watching the end of a movie or novel without watching the beginning. How can you figure out the real answers to the clinician questions without going through an entire case? I know that just the mere description of the findings helps me to come up with an appropriate conclusion. Without that process, my impressions are more likely to be off-the-mark. Don’t’ skip this routine!
Following A Radiologist’s Mantra: Don’t Skip Around!
Order matters. Whether you are skipping around instead of using routine search patterns, reading cases in an illogical order, or creating an impression before looking at and analyzing all the findings, you can negatively affect both your partners and patients. We want to do the best for our patients and work partners. So, the next time you decide to accomplish a professional task out of order, think twice. It may not be the best for patient care!