Month: December 2022

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How Much Detailed Description Belongs In Your Report As A Resident?

detailed description

Exceptionally few things can be more confusing as a resident than how much to put in a report. Each faculty member tells you something slightly different. Some want every little detailed description. And others want a dictation that is so short it may even skip over some of the relevant findings. Since the diverse dictations you read are so vast, and each attending does it differently, the variety of recommendations you receive is also all over the map. So, how do you decide what kind of dictation detail is right for you? Well, let me give you some pointers.

Don’t Get Too Deep Into The Weeds

Like I did when I started, I had noticed that many new radiologists would get into the nitty-gritty of the technical aspects of a dictation while forgetting about the ultimate desired result. We shoot for an answer to a question that the referrer is providing. And that is the main reason for the report itself. So, when you see a dictation continuing to harp on T1 and T2 weighting as well subtle points of artifacts and the finer points of a description that no one will use (including the subsequent radiologist that reads the report), it is probably too much. These reports typically have an impression that is a mile long and a result section that needs a table of contents! So, avoid too much technical jargon description.

Keep It A Little Bit Longer With More Detailed Description Than Your Attending- 

At the same time, for most attendings, you probably want to make sure that your dictation is a little bit longer than they would write. Why? Because your faculty precisely knows what the clinician needs from a report and the audience they are writing to address. You don’t know these factors as well. So, it pays to describe a little more than what they would place in their dictation. Additionally, as most attendings do, you should use the dictation as a guide so that you won’t forget what to add to your final note.

Make Sure All The Relevant Findings Are Present

If you are reading a trauma chest CT scan, make sure to put in the dictation that there is no mediastinal hematoma. That statement is probably not valuable if the patient is here for pneumonia instead. So, think about the pertinent negatives and positives you would need to rule in or rule out the diagnosis that the referring physician needs. Even if this adds a few lines to your report, it’s probably a good idea to add it because it can help to figure out the patient’s final disposition.

Be Sure To Make The Detailed Description As Objective As Possible

Objectivity trumps subjectivity any day of the week. Statements should be a matter of fact and not an opinion as much as possible. The extra vocabulary and detail that goes into a report with all the subjective phrases such as “I believe” or “appears/seems” are superfluous at best and harmful at worst. They indicate insecurity to the reading physician. And you probably know what that means! They are going to order more unnecessary tests based on your uncertainty. So, please keep your objectivity in your dictation!

After All Of That, It May Depend On Your Faculty Member

The final consideration you need to determine the length of your dictation is the faculty member reviewing your report. Unfortunately, at your stage, your dictation is not quite yet your own. So, make sure to write the specific details your attending requests. They are often apt to change whatever you finally say anyway. Therefore, make sure to do it the way they want the first time!

How Much Detailed Description Belongs In A Resident Report?

It’s a fine line between too much, too little, and just right in the resident’s report. So, please don’t go too deep into the technical jargon; keep it a little bit longer than your attending; ensure relevant positives and negatives are present; keep it objective, and remember your report is for your attending. These guideposts will eventually get your dictations to the appropriate mean that satisfies your faculty and the referrers so that they can interpret and understand your final read!

 

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What To Do With A Large Windfall During Residency

windfall

You may think it is just a pipe dream, getting an unforeseen large windfall. (and I’ve spoken about small windfalls before). Nevertheless, throughout my years of stewardship in the residency program, I have encountered a few residents who have had a significant life-changing amount of money fall into their hands. Some with cryptocurrency, others with family inheritance, and others with a stock pick that rose much more than expected. So, what is the best way to deal with a substantial windfall like this? OK. It might not happen to you. But it still occurs more often than you might think. And, if it doesn’t happen to you, it is still fun to mull over. So, let’s talk about some general advice about what to do with a windfall.

Give The Large Windfall A Little Bit Of Time To Sink In

In general, when you receive a windfall of a significant amount, your first thought is to do something immediately with the cash hoard. But your brain needs to catch up a bit with the reality of the situation. Typically, it would help if you waited a bit until the initial circumstances of the windfall had settled out. When it comes to money, emotion can interfere with the best and most rational choices that we need to make. So, give it some time. Waiting a bit won’t cause that much harm (just a little bit of a loss to inflation). But the opportunity cost of doing something rash with the money is much worse!

It’s Not All Or Nothing!

Just like you don’t want to put all your money on 00 on a roulette wheel (you will lose much more often than you will win!), don’t put all your money into one financial basket. Diversification is the name of the game. And you may want to consider not putting it all into one debt repayment or investment. Consider spreading out your newfound fortune on a host of different opportunities. It’s tough to predict the future. So, you are generally better off spreading your money into multiple options.

Consider Repayment Of Debt/Student Loans

Although many of your student loans are at low interest (or 0 interest rate currently), you should consider putting a large chunk of your fortune into your student loans. Why even at these interest rates? Well, there is always a risk that you may not be able to complete a residency, or an unforeseen event can happen that can prevent you from paying them back when the interest returns to normal. And student loans are generally not dischargeable in bankruptcy. So, taking these risks off the table is enormous. Furthermore, the peace of mind of knowing that your student loans are significantly smaller or even gone is priceless.

Savings/Investments

In addition to student loans, also consider putting some money away for a rainy day. Some good options you might want to consider as a low-paid resident will be an emergency fund for savings, a Roth IRA, or a hospital 401k if there is a match. And try not to buy individual stocks or bonds. That situation can lead you to a very undiversified state that can lose all your hard-earned money.

Other Depreciating Assets

Finally, if you still have some money left over, there is nothing wrong with a bit of enjoyment in your life. Just beware of taking too much to buy things like cars, boats, planes, or whatever else floats your boat. You may regret it later on. I recommend using no more than 10 percent for personal enjoyment related to these items. Otherwise, there is a good chance that you will regret any rash decisions you make for your future self!

Let A Large Windfall Be A Blessing!

Whatever the reason for the windfall, it is your opportunity to make it into a blessing instead of a curse. It’s an opportunity to make your life better and your future self happier. So, give it some time to sink in; don’t spend it all on one thing; consider repayment of debt/student loans, and enjoy a bit of it. Following these rules will make that obscene sum of money into something more than just a number. Grandma would be proud!

 

 

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Half The Battle Of Residency Is Just Showing Up!

showing up

During residency, life will present you with many options. Sometimes you can decide to study for the boards instead of actively seeking to learn new procedures or experiences. Or, there will be times when you can get out of work early in the afternoon because you went to a half-day conference, and no one is taking attendance anyway. But, radiology residency is only four years. And, the time you have to learn new procedures with experienced professionals and make the mistakes you need to make before you go out into the real world is limited. You may not realize now how critical it is to spend extra time learning what you can and taking advantage of each moment you have as a resident to know your future trade. Hopefully, you will have decades to practice and form the basis of this career in these four years. And half the battle of residency is just showing up. Here is why.

Technical Procedure Practice

Every procedure you complete later adds to your work’s cognitive and muscle memory. And, each time you do a technique again, you are adding a body of knowledge that you will eventually refer to you. It can be something simple as the best way to position a patient. Or, it can be a more complex set of wire movements. We become a bit better each time we complete one of these procedures.

Making Mistakes Now Instead Of Blindly Later

Because we are human, we will make mistakes. And the more mistakes you can make in a protected environment, the less likely you will make those same mistakes later in your career. If you miss a pulmonary nodule as a resident, it’s not a big deal. If you miss that same pulmonary nodule as an attending, it could be the beginning of a horrible lung cancer and a potential lawsuit. The more you miss now that your faculty picks up, the more you are likely to concentrate on those same areas later on so that you will never forget them again.

Showing Up To Expose Yourself To More Incidental Findings

In practice, some of the most complex parts of radiology are not necessarily the specific disease entities. Instead, it is those pesky findings that we make that we can’t but see. Some of them, like pulmonary nodules, have defined Fleishner criteria for following them. However, most don’t have particular rules. And, sometimes, you have to rely on your experience to figure out what to do next. That is something that you can only receive by showing up and reading!

New Disease Entities/Presentations

The more times you see cases, the more likely you will see new presentations of diseases that you know and other findings of pathology that you don’t. It’s like a lottery. Eventually, after a certain number of times, your number will come up due to the odds alone. Why not increase those odds by showing up to your training during residency?

Subconscious Identification Of Normal Variants

Finally, sometimes it’s not the material that we know. Instead, it might be the little findings that we don’t pick up. Subtle curves and lines we all pick up each time we look at an image. Sometimes, we are unsure which ones we can disregard and which are critical. It is only through putting through the motions of reading lots of cases that we can get to the point of confidence. All it takes is to show up!

Every Moment Of Showing Up To Residency Is Important!

Those moments you take advantage of instead of sitting back contribute to your overall body of knowledge even though you may not think much about it at the time. So, take the bull by the horns and practice technique, make mistakes now, and expose yourself to incidental findings, new disease entities, and normal variants to become the seasoned radiologist you need to be. Showing up is half the battle!

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Be Careful Of Some Of Dave Ramsey’s Financial Advice. It May Not Apply To Radiologists!

financial advice

Over the past six months or so, I started to listen to Dave Ramsey. He is a no-nonsense straight shooter who gives excellent financial advice to folks who call into his show. Moreover, he has an infectious laugh and is very witty. If the topic of finance interests you, once you start listening, it will become addicting! Nevertheless, we as radiologists must be careful when we take some of his advice at face value. Some of his advice does not apply well to late-blooming indebted radiologists who make a very high income. So, what parts of his advice should we think twice about? Here are several recommendations that probably will not apply to you.

Save Only 15 Percent Of Your Income

As radiologists, we are late bloomers. We enter the workforce much later than non-physicians. And we start working a bit after our general medicine colleagues. Therefore, the time value of money does not work in our favor. This rule makes a lot of sense for most people who start working somewhere in their twenties and continue working through retirement. But, for us, we cannot capture the benefits of compounding interest. Therefore, we need to save far more than 15 percent. Fortunately, most of us can do so, given that our salaries are far from the average worker in the United States.

Buy No More House Than 25 Percent Of Take Home Pay With A Fifteen-Year Fixed Mortgage

On this point, we partially disagree. Dave Ramsey is not steadfast with this rule but recommends this protocol to his callers. Spending less on the house allows us the freedom to save for other events like college for kids or retirement savings. Nevertheless, many of us have rapidly rising incomes right after residency. And just because you are making a particular salary directly after you finish does not mean you will stay at that number much longer. Many of you will become partners and shareholders in practices and may have buy-ins that will temporarily decrease your salary. And, you may live in an expensive part of the country. With the expectations for increasing wages, you should be able to buy a bit more house based on a than 25 percent based on a reasonable expectation of making more money in the future. So, consider your future earnings when you buy a house so you don’t have to move twice!

Use Managed Stock Mutual Funds With A Great Track Record Instead Of Low-Cost Index Funds

Generally, most index funds beat managed funds over the long term as an investment vehicle. Dave Ramsey tends to say that his managed funds tend to outperform. But, for most, the outperformance is usually limited in scope and doesn’t last for long-term managed mutual fund holds. Furthermore, the fees in an actively managed fund tend to be a bit higher. So, consider opting for the lower-cost index mutual fund if possible!

Dave Ramsey Financial Advice Doesn’t Talk About Real Estate Syndications As An Option

Since we are high-income professionals, many of us don’t have the time or inclination to buy and take care of houses for investment. Additionally, buying stocks in taxable accounts can cause radiologists to pay significant capital gains and dividend taxes (as high as 33 percent or more if you include both federal and state taxes!). One excellent option he does not discuss is using private syndications and real estate funds as an investment tool for increasing wealth and cash flows and decreasing the tax burdens you might face with other types of investments. These investments can be low maintenance and strategies for building wealth for the high-income professional!

Dave Ramsey And Financial Advice

Dave Ramsey does a great job of spreading great information to the average financial media consumer. But no one is perfect, and personal finance is personal. Therefore, one talking head that generally gives excellent personal finance advice may not apply to your particular situation as a radiologist. So, although this show is entertaining and often relevant, do your due diligence when considering your options!