Month: May 2022

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Hospitals Need to Invest More In Radiology IT Support!

radiology IT support

In an environment where hospitals’ profit margins are becoming tighter, what is the most likely area where they can cut costs? Well, it’s undoubtedly not surgery or nursing. That would look not very good for the hospital and drive competitors elsewhere. Could it be hospital beds? No, because that would lead to direct patient complaints and less capacity. Is it the high-tech equipment and hardware? Not usually, because that is a great marketing tool to get doctors to refer patients your way. Instead, unfortunately, the places where a hospital can cut costs are usually the behind-the-scenes. And one of these areas on the chopping block is radiology IT support.

Who cares if the radiologists if a radiologist’s job is more demanding? It doesn’t affect the hospital’s bottom line, right? Does it matter if the radiologists must stay an hour later to deal with PACS crashes, firewall issues, and incompatibility with outside studies? The radiologists need to get their job done anyway for patient care. Well, that philosophy has become commonplace in the world of hospital savings.

In reality, the costs of not supporting a hospital’s information technology are enormous. It decreases efficiency for doctors, patient outcomes, and staff morale. And hospitals certainly do get complaints, albeit on the back end. So, what are the tangible results of having poor IT support, and why should hospitals treat this issue as mission-critical for the system. Let’s delve into the reasons why.

Radiology IT Support Allows For Quicker Turn Around Time

Turnaround time is one of those statistics that hospitals hang their hats on to show that they are efficient. And what is one of the most significant factors in a delayed turnaround time? Well, it’s the radiology study. The time it takes for the patient to have dictated images is widely dependent on having a constantly functioning PACS and dictation system. Patients will have to stick around longer without a functioning IT support system, a money-losing proposition.

Better Patient Treatment

Not having IT support may mean malfunctioning networks and servers for many reasons (decreased bandwidth, storage capacity, etc.). Often, this process results in loss of access to priors. And guess what? As I said in my previous rant on priors, this leads to poorer patient care because of decreased specificity and sensitivity. Or, it can even lead to disastrous outcomes if you can’t process studies like CTAs of the brain. And these are just some horrible outcomes of many!

Increases Morale (Waiting on The Phone)

Want to keep your doctors within the hospital system in a competitive market. Then be sure to support IT. Radiologists, physicians, and nurses are more apt to leave when they notice a constant breakdown of the electronic health records and PACS systems. These nagging factors are a continuous source of reported physician burnout (among others). We should be trying to maintain our physicians, not creating a revolving door!

Increasing Patient Satisfaction Scores

One of those other factors that hospitals love to tout is their patient satisfaction surveys. Hospitals regularly feature positive survey outcomes on billboards and commercials to show that they are competent institutions. Well, guess what? Those scores will not cut the mustard if patients have to stay in-house because no one can access the electronic records!

Saves Hospital Costs

The costs of malfunctioning electronic support systems are substantial. Imagine having to keep your patient for extra days in the department because a lack of support prevents patient discharge. Based on this issue alone, costs skyrocket to thousands of dollars per day for a hospital stay. And this doesn’t account for all the other expenses that a poorly served electronic health records and PACs system entail!

Radiology IT Support Is Not An Option That Hospitals Can Skip!

Although many hospitals would like to skip this “expensive” service to save money, you need the full-time support of a dedicated IT team for better patient care, decreasing hospital costs, and increasing the system’s efficiency. Although not evident on the front end, the downstream effects can be enormous. By not supporting IT, hospitals are merely shooting themselves in the foot. It’s not an option that hospitals can skip!

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Three Days May Be The Optimum Workweek For A Radiologist

optimum workweek

With the onset of Covid, between late March and April 2020, imaging volumes suddenly dried up for many radiologists. This change brought radiologists a taste of what life would be like if we had only to work three days a week. And, it was not so bad. Sure, radiologists did not bring home as much income. But, it was certainly nice to have multiple three and four-day weekends. It was sort of a sampling of the life of three days a week for radiologists. For many radiologists, this became a dream to continue to work with such a shortened optimum workweek. And these are the reasons why.

More Refreshed At Work By The Optimum Workweek

If you only have three days at work as an optimum workweek, you are more likely to have increased time to rest and relax on the days you are off. Therefore, radiologists felt less hurried and calmer on their workdays. We had more time for lunch and could even check the internet every once in a while. Not only that, we could savor every case. We could read about diseases and take the time to learn more with each Google search. This more lackadaisical attitude was refreshing for its time.

More Outdoor Exercise

As opposed to the pandemic, many radiologists became healthier because they had more time to walk and run outdoors. We spent more time out of our seats and less time staying in one position. My walks with my dog became longer. And, it was not just because spring had sprung.

Time For New Hobbies

During this time, many of us started to participate in new endeavors. Whether just to keep your hands busy, such as knitting, or to increase your daily output of exercise by running, many radiologists began exploring all sorts of activities they didn’t have time for. Some even lasted past the time of the pandemic.

Time To Go Back To Old Hobbies

Others began pursuing activities they could not before because of lack of time. I spent more time learning a couple of languages and learning guitar. With three days’ work, pursuing these hobbies could become more permanent.

Home Repairs

I am not a home repair guru. But, for many folks, all of a sudden, home projects that we delayed for lack of time no longer sat fallow. We repaired sinks, rooves, shelves, and more. When you have the time, it is much easier to complete do-it-yourself home projects.

Traveling On The Weekends With The Optimum Workweek

A three-day workweek, flanked by extra days on either weekend, leaves some time for weekly travel if you choose. Sure, it wasn’t easy to go abroad at that time. However, many of us opted for local jaunts to the country or local getaways. This experience was not so bad!

More Time With Family

With kids at home from school and radiologists spending more time at home, many families became closer and more tight-knit. We spent more time with our spouses, dogs, and kids. That’s what a three-day workweek could do!

A Three-Day Radiologist Optimum Workweek, Not So Bad!

Sure, working five days a week in the United States is standard. But, if you can afford the living standards, there are many advantages to working three days a week as a radiologist. Whether spending more time doing what you like or just feeling refreshed and excited about your next case, the three-day radiologist gig can work for you!

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The Magic Of Priors

magic

As I was scrolling through the worklist, I came across a case with priors that significantly changed the disposition of a patient, emphasizing the magic of priors. A chest CTA showed numerous pulmonary emboli sitting in multiple branches of the pulmonary arteries. At first glance, any radiologist would be ready to pick up the phone and call the ER to let them know about the pulmonary emboli. Of course, this patient would most likely need anti-coagulation and possibly thrombolysis. But then, at the very end of the list of prior studies, I noticed a previous chest CTA from 2017. To my surprise, the images looked the same. Those bilateral pulmonary emboli were most likely chronic! No new treatment would likely be necessary. If you want to talk about why priors are so important, this is an excellent example of why. It entirely changed the management of this patient. And it is the proverbial tip of the iceberg. So, if you ever get that feeling of laziness, here are some reasons it pays to take the time to press on and look at the patient’s prior studies.

Increases Sensitivity

No, it is not cheating to look at the prior report. Instead, it is excellent patient care. Some lesions, for instance, pancreatic lesions, can be very subtle. And, if you don’t look back at the prior report and the prior study, you are much more likely to miss it. You may neglect to recommend follow-up on this sort of lesion. And, in this case, you never know what can happen next. It can grow and need further treatment or not. Regardless, why not increase your chances of picking up significant findings?

Increases Specificity

Let’s give the example of that lowly nonspecific liver lesion that we always seem to find. The second time around, the diagnosis can become a lot more specific. If the lesion has been stable for the past ten years, it is highly likely to not be malignant. And, you have made of critical management decision of leaving the lesion alone. Otherwise, a whole workup can ensue, wasting health care dollars and causing potential psychological discomfort to the patient. These issues happen all the time, so don’t forget to compare to the priors.

The Magic Of Priors Changes Patient Treatment

I can’t tell you how often I get calls from oncologists that fail to give us the most recent priors, subsequently add them to our system, and then request an addendum. Why is that, you might ask? Well, most oncologists know the value of comparing to priors. How would you know whether to continue on a chemotherapeutic regimen or not? In an imaging study, learning if there is improvement, stability, or progression takes the guesswork of how to treat the patient next. And this is not to mention the potential life-saving acute issues I mentioned with the chronic PE case at the beginning!

Increases Referring Physician Confidence

Knowing that you have an eye on the previous study on all your reports allows your referrers to feel comfortable that you are safely and methodically correctly interpreting images. Of course, this step can lead to a virtuous circle. You get more patients referred because you increase clinician confidence and patient well-being. And, you earn a better living. It’s all good!

The Magic Of Priors

One of the big life lessons of practicing radiology for so many years is to avoid neglecting prior studies. I have seen one too many cases slip through the cracks, and I certainly don’t want the same to happen on my watch. And, I am sure that you probably don’t want that on yours. So remember why the magic of priors is so essential- increasing sensitivity and specificity, changing patient management, and increasing clinician confidence. And, you should make it part of your standard protocol never to forget to look at them too!

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Should You Pull The Trigger In This Housing Market?

housing market

Lately, I have been speaking to some younger radiologists about what to do in this housing market. Interest rates are climbing. With that, housing prices continue to rise, making homeownership even more expensive. Moreover, many folks want to start a family in a “big-enough” house to meet their needs. But, monthly payments are climbing higher and higher to pay off a 15 or 30-year mortgage. Is it worthwhile to wait, or should you jump right into the housing market? Let’s discuss some of the benefits and disadvantages of delaying vs. waiting so you can make the right decision for yourself.

Reasons Why Buying A Home May Not Make Sense In This Housing Market

You Are Not A Partner Or Tenured Attending Yet

This rule works. You never know for sure what will happen before you can claim the status of a shareholder or partner. I know countless stories of folks buying their houses only to discover that they did not receive their vaunted position. Some, then, feel the need to leave. And, with that, you will probably have to sell your house. Rarely, when this happens, do you make money on the transaction because of all the fees and taxes that you will pay with little or no equity. Even worse, if the market turns bad for sellers, you may not be able to sell your house. So, regardless of the interest or economy, it is usually not in your best interest before you know you will stay in the area.

Higher Payments And Not Enough Down Payment For This Housing Market

Getting a mortgage below three percent in the current mortgage market will no longer happen. So, you can expect your payments to be a lot higher than they would have been just a few months ago. This situation is especially true when you have not built up enough downpayment. So, if you don’t have the cash to make the new payments based on higher mortgage interest, don’t purchase the property. You will become “house poor.” And you will not be able to build wealth so quickly outside of your house.

You May Need To Move Again

Maybe you are thinking about changing jobs. Or, you are thinking about buying a house for your current family, but you are about to give birth to a set of twins. If you have a good chance that you will have to move soon after purchasing your house, it is better to delay the purchase until you know what you will need. Transaction costs and taxes for buying and selling real estate are prohibitively expensive. Moreover, these costs don’t even include the hassle of moving and purchasing a place twice. So, if you need to move soon, you are better off waiting until you know what you want!

Renting Can Be Cheaper Than Owning In This Housing Market

In some situations, renting can be a better and less expensive option than owning a place. In high cost of living areas, especially, buying a home can be unaffordable. Mortgage payments can dwarf what you would pay for a monthly rental. But, you need to do the math to see if it works out this way.

Reasons Why Buying A House Now May Not Be So Bad In This Housing Market

Just Because Interest Rates Are Rising Doesn’t Mean Housing Prices Will Fall

Sure, rising interest rates can affect the demand for housing. However, historically speaking, many periods of rising interest rates have not included a time of declining prices. And that is because housing prices are subject to many other factors such as availability, demand, employment in the neighborhood, and more. So, if you buy a house now, it does not necessarily mean you will lose your shirt even though you are paying more for the house and the mortgage interest.

Yes, Interest Rates May Go Down After Going Up- You Can Refinance!

Just because interest rates are high now does not mean that they will remain the same forever. Remember, buying a house is a long-term purchase, and you will likely own it through higher and lower interest rate environments. So, you may have the opportunity to decrease the interest you pay later. The longer you hold on to your house, the more likely that this situation will happen to you.

You Need A Place To Live- So Why Not Build Equity?

Perhaps, you have a family and need a decent-sized place to live now. Sure, you could find a rental now. However, if you have a stable situation, it may pay to build equity in a house. Of course, that assumes that you have saved up for an emergency fund, home down payment, and paid off a significant chunk of your loans. But why not build roots and own something if it makes sense?

You Are In A Stable Situation

Maybe you have become a partner or have loads of family around, and you know that you will be around for a very long time. The longer you stay in one place, the more likely you will ride out any downturns in the housing market. And the more likely that you will come out ahead when you finally decide to move.

Should You Pull The Trigger In This Housing Market?

Waiting to buy a house or purchasing a home is a personal decision based on many factors, some of which I have listed above. So, consider the amount you have saved, your job situation, your family, and the deal you will get when making this decision. Currently, buying a house is not a simple decision as interest rates and prices are relatively higher, but it can make sense!

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Let’s Go Back To The Fundamentals Of Radiology

fundamentals

Yes. I lived in a different world from residents today. We didn’t have all the electronic resources such as virtual flashcards, digital ebooks for almost everything, Radexams, Case stacks, Radprimer, question banks, and other online electronic resources. In addition, there were fewer texts for every topic than what we see today. And, we had only one general review text for the boards (Dahnert). But, as I remember, almost all radiology residents back in my day would read these topic-based physical textbooks to understand the fundamentals of radiology. We needed to read this material to grasp the essence of what we needed to know. Many of today’s residents no longer ascribe to this philosophy and jump right into other ancillary electronic material. 

Moreover, without reading the textbooks that I did when I started, I would never have had the fundamentals I have today to synthesize findings and differentials quickly. By skipping out on reading the fundamental texts, residents build knowledge layered upon a flimsy thin base. They can’t answer the why and how of what we do. And they are much less likely to pass the written board examination. This result is precisely what we ultimately find. So, let’s talk about why returning to reading primary physical textbooks is critical before jumping into all the electronic resources.

Active Learning With A Physical Textbook Is Better For The Fundamentals

Reading with a physical textbook rather than electronic reading material is more efficient. If you are not convinced, take a look at my former article, eBooks vs. Printed Radiology Books- A Death Match Part II. In this article, you will find evidence that using physical texts is better than electronic material for learning material. Holding a book in your hand, highlighting, and taking active notes on flashcards, is more efficient for remembering the material. So, although more portable, electronic resources may not give you the same bang for your buck.

Putting Your Money Where Your Mouth Is!

I know. Many of you have tons of debt from medical school. However, when you pay for something, you establish an unwritten commitment to it. So, when you buy your textbook, you are much more likely to feel like you have to use it, read it, and mark it up. Sharing ebooks with your colleagues is just not the same. Therefore, you should consider going back to the old-fashioned concept of owning your textbooks to increase your retention and maximize the possibility of passing the written boards.

Much Better To Have Conceptual Learning Than Learning Lists!

To this day, I can still remember where and when I learned certain concepts, such as features of extra-axial vs. intra-axial brain tumors (check out Osborn!) or patterns of arthritis (Arthritis In Black And White). When you go directly to the electronic references without reading these source textbooks, you are much more likely to see random lists without knowing the why behind the finding. And, you are much less likely to remember the key concepts that will help you make diagnoses later on. You know what they say – give a man a fish, and he will eat for a day. Teach a man to fish, and they will be able to eat for a lifetime! It’s true! So, make sure to learn the concepts from the text first!

More Difficulties With Complexities And Artifacts

It is much easier to figure out complex problems that don’t follow the rules if you know the basics. And, in radiology, very few cases are precisely what the literature describes. When you know the concepts behind the images, you can adjust your ideas to suit the case and allow you to make the appropriate differential diagnosis because you understand why it can fit what you are seeing. When you are reading electronic material distilled down to the bare bones, you lose out on this ability to make the diagnosis when it doesn’t necessarily follow the rules!

Getting Back To Fundamentals!

I am a purveyor of electronics. It is fun to play around with cell phones, computers, and gadgets. But, based on real-world experience with resident success, I implore residents from the first through third years to opt into reading primary textbooks to establish foundations in their knowledge base. Electronic media does play a role in learning. But, residents should consider delegating that role to the reinforcement of knowledge and not as a place to start. In the end, it is your choice. But, residents that read the introductory texts do better on the boards and make themselves better radiologists!

 

 

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