Year: 2022

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Find A Radiology Residency Or Job That Will Feel Like Well-Worn Sneakers!

sneakers

I don’t know about you folks, but when I buy new sneakers, I expect it will take a while before I can break them in. The material needs to stretch out to surround and cushion my foot gradually. Rarely do the sneakers fit perfectly on day one. The process can take months or even years until I get them the way I want. So, I buy them with the expectation of future comfort, not how they feel today.

If I try to buy the perfect sneakers, it never seems to work. I find myself returning lots of footwear (online nowadays!) And, I waste my time and incur multiple restocking fees or trips to the store for returns. So, what do I look for when I buy those sneakers? I look for reasonably comfortable pairs that fit snugly without too much discomfort. Also, I find pairs that will less likely cause me to trip over myself. So, what does this all have to do with radiology? It’s coming out of the left-field, right? Well, not really. Let me explain.

Like buying sneakers, residency programs, or first jobs rarely fit perfectly on that first day. It may be good enough and may have the potential to work well. But, you may notice the imperfections at first. These imperfections may trouble you because you may question if you made the right choice or not. But it would help if you had patience. Why? Because the outcomes can be costly, just like the returned footwear. And here are some of the reasons why.

What Doesn’t Work Perfectly Now Will Get Better In The Future

All the imperfections tend to loom larger when starting a new job or a new residency. You notice the worn call room or the resident that constantly complains. What else do you have to hang your hat on? But, I can assure those same issues that you see right now will most likely go away. Yes, you will face other problems and challenges as well. But, I have never seen anyone join a practice or begin a program that is perfect on the first day, week, or month. It just takes a bit of time for the sneaker to mold to your foot!

You Gain Familiarity With Your Colleagues- First Impressions Are Rarely Correct

How often have you noticed that your roommate or teacher was not as they first seemed in your academic career? In my case, I know that my first impression was often wrong. The teacher that seems bizarre often turns out to be the best. And, that roommate that you thought was off a bit may turn out to change your life. It’s all a matter of perspective. And, in the beginning, our views can be skewed. This sensation can feel just like the sneakers that may be a little bit tight at the top at the beginning!

The Costs To Changing Sneakers (Jobs) Are Immense

It is not so simple if you are leaving your residency program midstream or deciding to change to another faculty position elsewhere. Especially as a family, the costs of uprooting your accommodations, kid’s schools, or workplace are immense. Just like when you constantly have to pay those restocking fees, the price of changing jobs can add up over time and can become exceedingly difficult to recoup. It’s worthwhile to give your present job a second look to make sure that it is not what you wanted in the first place. 

Give The Well-Worn Sneakers (Residency/Job) A Chance To Support And Comfort You!

All outstanding accomplishments take time. So, give your residency or job a chance. Yes, there are times where a sneaker can break, or a rock gets stuck in the sole. In these unusual cases, the damages are irreparable, just like some rare residencies or career paths. But, those times are rare. In the end, you may find that you will live a much more comfortable and happier life if you stick it out a bit. Your feet will thank you!

 

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Why Radiologists Cannot Be Over-Confident!

over-confident

Some subspecialists make fun of radiologists because our favorite plant is the hedge. (An ancient lousy joke!) To the other extreme, I have found that those radiologists that are over-confident of their diagnoses tend to make the worst radiologists. Many residents don’t realize this, and some emulate these single-minded radiologists because they believe excess confidence helps patients and physicians. But, when they get out into practice, they recognize the error of their ways. And, quickly, they reverse course. So, let’s go through why that is the case before you may become one of those casualties. And then, I will provide a simple solution to get your point across without sticking to one foregone conclusion.

Why Radiologists Cannot Be Over-confident

Zebras Do Occur (Even For Over-Confident Radiologists!)

Of course, not all of our diagnoses have simple outcomes. For every 1000 peri-tonsillar abscesses, there are a small number of infected squamous cell carcinomas. And, there is also a smattering of even rarer birds that happen from time to time. I’ve been around a bit to see a lot (although not everything!) And, I know enough not just to hang my hat on my one beloved diagnosis.

All Of Us Sometimes Have Blinders On

Just like other clinicians, histories can sway us. If your ordering doctor constantly pushes toward one ineffable diagnosis, you, as a radiologist, are most likely to think the same. And that is the moment when you need your radiology cap on your head. Those intense pressures can easily lead you down the wrong road. At this point, we need to step back and reanalyze the situation and think about all the possibilities, not just the most likely.

The Legal System Is Not Forgiving

What do you think about when you see a bit of bowel wall thickening in a small bowel loop with no pneumatosis, free air, free fluid, focal fluid collections, or extraluminal contrast. Usually, it is infectious or inflammatory enteritis. But every once in a while, it turns out to be something much more malicious. Perhaps, the earliest sign of ischemia? I have seen multiple radiologists not mention the word ischemia somewhere in their dictation. And, the outcome for the physician (and sometimes the patient) has not necessarily turned out so well. The legal system does not allow for finite diagnoses, especially when one of those more unusual diagnoses can lead to a not-so-great result!

Potential Bad Patient Outcomes

And, most importantly, like in the ischemic small bowel example above, when we limit our differential diagnosis, we can also affect patient outcomes. Some clinicians will keep the alternative diagnoses in the back of their minds or will prophylactically treat for these entities even though it may not be your first suspicion. And, even though you may put these diagnoses third, fourth, or fifth on the list, it doesn’t mean it shouldn’t be in the dictation. We have to allow our clinicians to be aware of the unforeseen to prevent these bad outcomes.

How To Solve The Problem Without Being Too Hedgy

Given all the pitfalls of the over-confident radiologist, we usually should not come down too hard on one diagnosis. Instead, we have to give more than one option to clinicians because multiple possibilities exist. Yet, it is effortless for radiologists to get bogged down in a list, which also does not help the clinician. Suppose you come up with a list of differentials on a chest film of ARDS, pneumonia, or pulmonary edema; how does that help the clinician? How can you escape this hedge-like conundrum? 

Very simple. Ensure your reports talk about the diseases and a list of probabilities to go with the diagnosis. For instance, if you are leaning toward the diagnosis of pneumonia, you can say that the study is most consistent with pneumonia because of the fever and the multifocal pattern. But, make sure to say that other etiologies are less likely, how much less possible, and why. This technique allows us to guide the clinician toward the most likely diagnosis.

Instead Of Making The Mistake Of Becoming An Over-Confident Radiologist, Master Probability!

Radiologists have lots of diagnoses from which to choose. And, any one of these, albeit unlikely, can come true. So, we can’t afford to become overconfident and make the mistake of picking just one. Therefore, radiologists need to become circumspect and know the likelihood of outcomes. Our role is to guide our fellow physician colleagues. Thus, to become excellent radiologists, we should not adopt the tact of overconfidence. Instead, we need to become masters of managing probability!