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Posted on October 14, 2017April 14, 2022 by Barry Julius

How-To Procedure Manual For The Klutzy Radiologist

Some of us are not born to be athletic and coordinated like Michael Jordan or Pele. It’s just not in the cards. As a part of this group, I can remember many simple radiology procedural activities challenging me that would make the average resident wonder! Simple things like putting on sterile gloves and coiling interventional wires seemed like rocket science. However, hope springs eternal. And, believe it or not, many strategies exist to allow the klutzy radiology resident to become an expert at performing a procedure. We will discuss these today in this mini procedure manual.

Read Everything You Can About The Procedure

Procedural work is not just about performing manual tasks. It involves significant preparation and planning, both from a hands-on and an intellectual standpoint. Therefore, your role is to know all you can before performing the procedure. Some of the questions you need to be able to answer before any procedure include: What is the reason for the technique? Is it appropriate for the patient? What are all the tools and equipment needed to complete it? How can you avoid complications? And, if a difficulty arises during the test, do you know what you have to do next? And, of course, what are the appropriate ways to manage the patient after you have completed the procedure?

In addition, nowadays, most procedures have an associated “how-to” article or procedure manual in the literature that can help you understand step-by-step how to perform a technique. Not only do you want to read each of these articles, but you also want to live and breathe all the information in it. What do I mean by that? If you can, mentally picture yourself performing the procedure steps before stepping into the interventional suite.

Gather All The Relevant Patient Information

Patient research beforehand can be just as important as the procedure itself. You need to be able to complete the appropriate test for your patient. If not, you can cause additional radiation exposure and potentially irreparable harm.

Therefore, gathering relevant patient information is essential before performing any procedure. What do I mean by that? Here are some of the pertinent questions you want to answer. Does the reason for the technique match the history of the patient? Is the patient able to consent? Are all the appropriate blood tests completed before starting it? Do you know of anything about the patient’s history that would increase the likelihood of complications? And so forth. Ensure that if your attending asks you something about the patient before its performance, you know the answer. It will come back to bite you if you don’t.

Practice Outside The Interventional Suite

As Malcolm Gladwell states in his book Outliers, you need to do something 10,000 hours to become an expert. Therefore, your work mustn’t end after the initial steps. If you have problems coiling a wire, practice the maneuver at off-times at work or home. When you have difficulty putting on sterile gloves the right way, take a pair and practice. If you have problems with suturing, learn needlework. Especially if you are not a member of the athletic/coordinated club, you will need to practice, practice, practice until you get it right!

Volunteer Ad Nauseum

Lastly, you need to develop the qualities of grit and perseverance. When a procedure is available, take the opportunity to participate. Don’t be a wallflower. One of my program directors during my residency repeatedly stated, “Radiology is not a spectator sport!” He was right. Procedural comfort is directly related to the number of times you have completed a procedure. So, go forth and participate as much as possible!

Read This Procedure Manual Again If You Have Doubts!

Everyone has some deficiencies, and we are not born perfect. We need to proceed with hard work and determination to overcome these weaknesses. Procedural skills for the klutzy resident are no different. So go forth and read avidly about procedures, gather the appropriate patient information, practice outside the interventional suite, and volunteer repeatedly. No matter if you are a bit klutzy. You, too, will have the power to master any procedure if you follow these basic guidelines!

Posted on October 12, 2017February 3, 2022 by Barry Julius

Radiology Swap- University Radiologist Goes To Private Practice (Part 2)

Today we return to Part 2 of our Radiology Swap blog. Click on Radiology Swap- Radiology Private Practitioner Goes To University (Part 1) to catch up if you missed the first part of Radiology Swap!

University Radiologist Goes To Private Practice

Day 1 Radiology Swap:

Unaccustomed to working in a private office, the University radiologist is surprised by the relatively small size of the office. The parking lot is not too full, and he can walk rapidly from his car to the office, very different from usually having to walk from the back of the parking lot—a nice perk.

Finally, entering the building, he locates his workstation and seat. As soon as he sits down at the desk with the PACS monitor, a technologist dumps a stack of papers with today’s work next to the monitors. It must be about 150 cases. Where are my resident and fellow? I need them to help me with the dictations! Oh, my God!!!! I just realized that I forgot how to use a dictaphone.

After struggling with dictations and having read maybe 10 of them, 11 AM rolls by as he teaches the technologists about the ultrasounds they show him. But, the technologists roll their eyes as they just want to get through the cases so they can go home. They sense him droning on and on! He looks at the stack of papers given in the morning. It still looks the same!

Noon: He begins to receive phone calls, not happy ones. Clinicians are asking him about the results of chest x-rays, ultrasounds, and MRIs. Unsuccessfully, he tries to soothe them and let them know he has not looked at them yet, but he will get to them! No lunch for me.

Eyes reddened, head bleary, and voice cracking, the University radiologist now realizes it is almost 5 PM. He has only finished maybe half of the stack of orders. Lots more to go. No one to talk to. I can’t leave yet to get to the family.

10 PM arrives, and he is finally finishing his last dictation of the “day.” How does the private practice radiologist do it?

Day 15 Radiology Swap:

He arrives wearily into the office, looking haggard and worn with a 15 lbs weight loss since he started the job (1 pound per day!). His temper flares every once in a while, taking out his frustrations on the constant bombardment by the technologists by making snide remarks and yelling at the staff’s mistakes. For the past 15 days, he has left the office in the dark, no earlier than 8 PM. No direct contact with interested learners or other clinical physicians. All interactions on the phone. So, this is physician burnout!

Day 30 Radiology Swap:

Assessment day for Radiology Swap!!!

Practice President: So, you have worked in our practice for the past 30 days? Let’s start with the good part: I’m glad to see that you have made it through the encounter.

Academic Radiologist: Yeah, barely. How do you guys do it?

President: We do it efficiently to make money. The more we read, the more we earn. It keeps us going. In any case, let’s continue with your review. We received many complaints from our staff that you were curt and inappropriate at times. It was like pulling teeth to get you to do fluoro cases on our patients. You kept on grumbling- “Where’s my resident?”

Academic Radiologist: I thought you would at least provide me with a physician assistant to help with daily work. I don’t usually touch patients. My residents do it for me.

President: We also received numerous complaints from our referrers that they did not receive their reports in a timely fashion. We lost some serious business this week.

Academic Radiologist: When you get 150 new studies per day, everyone has to wait!!!

President: I don’t think we would be able to keep you here because we need radiologists to keep up with the work. We don’t get paid if we don’t read the minimum volumes!

Academic Radiologist: The best part of this job was the 15 lbs weight loss! I can finally get some sleep again. His eyes begin to close, dreaming about returning to his academic position.

The Radiology Swap Meetup

So, the academic and private practice radiologists now seat themselves in the same room to share their experiences after having returned to their respective jobs.

Private Radiologist: How do you do your job on a daily basis without getting totally bored?

Academic Radiologist: How do you do your job without getting totally burnt out?

Private Radiologist: Let’s agree that we are not right for each other’s jobs. It would never work out for us.

Academic Radiologist: At least I can understand what you go through on a daily basis. We used to make fun of private practice radiologists. Don’t think that I will do that anymore.

Private Radiologist: Doesn’t mean that we can’t be friends. Let’s go out for drinks! I think we both earned it…

Academic: True. We both earned some stiff ones.

The radiologists leave the room and head down the street, never to look back on their former residency swap experiences again and happy to go out for some drinks…

THE END

(until next time!)

Posted on October 8, 2017May 24, 2023 by Barry Julius — 3 Comments

Want To Be A Successful Radiology Resident? Learn To Triage!

When program directors hear complaints about their residents, we find most do not stem from resident incompetence. Nor do the complaints relate to professionalism issues. Instead, a good majority arises from a lack of a timely response to reading cases. And these delayed reports result from a lack of appropriate triage. So, I think you know what we will talk about today. You guessed it! The topic is tadaaaa… how to triage your cases.

A Common Scenario

It’s 2 AM, and a bleary-eyed resident starts to pick off STAT CT scans from the worklist to catch up on his reading from the nighttime. A house physician rushes down from the floors to speak with the resident in a huff. She explains that she needs to discuss a case from a week ago that she must present for the tumor board the following day. The resident obliges. Thirty minutes pass, and the house physician leaves.

Next, a few minutes later, an ultrasound technologist stops by the reading room because she questions whether a renal cyst is simple or complex. Like a robot, the resident scans the patient in the ultrasound room to make the determination. Another 30 minutes go by.

While scanning the patient, the resident gets two beeps which he needs to call back. He gets to both those phone calls. One of the phone calls comes from a patient’s father, who asks a question about his son’s chest film from the previous day. The conversation drones on for 15 minutes, and the resident can barely get off the phone. But he does eventually. Right afterward, he quickly responds to the other phone call and promptly answers the nurse’s question on the other end.

The resident starts to reread the CT list, and a technologist interrupts his train of thought as he walks into the room. Solemnly, the technologist asks, “How much contrast should we give this patient with a slightly low GFR?”. Immediately, the resident attends to the technologist. However, the resident is unsure and looks through the literature to find the appropriate answer. After 10-15 minutes, he finds a piece of paper and says, “75 ccs of Visipaque.”

Finally, an angry emergency department attending calls to the radiology reading room, “Where the hell are the results from the nighttime CT scans? We have been waiting 4 hours. Sorry, but we are going to have to write this up as an incident in the morning!” Where did the time go by?

Ways To Triage In The Above Scenario

So, what could this poor weary resident have done differently to prevent himself from getting written up by the ER doc? Well, lots of things. For one, did he have to review the tumor board case with the house physician? No. Should he have spent 30 minutes determining whether the renal cyst was simple? Probably not. The resident could have delayed until the morning. Did the resident need to speak to the patient’s father for so long? I don’t think so.

To summarize some of the problems the resident experienced with triaging in the scenario above, I have divided some of the main concepts about radiology triage into the following paragraphs. Here are some general recommendations for triaging cases to avoid situations like this.

Keep Your Eye On The Prize

Remember… When you are on call, the first goal is not to kill anyone, and the second is not to injure anyone. By ignoring the STAT list and tending to other people’s “problems,” you are increasing your chances that something terrible will occur. Perhaps, the CT Abdomen/Pelvis for appendicitis with a positive study will get delayed. Or, you will miss that opportunity to catch that hemorrhagic stroke before it is too late. Delaying STAT reads can theoretically cause irreparable morbidity to your patients. Therefore… Keep your eye on the prize. Complete those studies that are urgent first!

Also, if the activity is not critical, you can delay it until the following morning. In the case of the ultrasound technologist questioning a cyst above, sure, it is an important question to answer. But not so much when you have a list of 5 or 10 STAT CT scans you need to look at. You always have the option of delaying such study until the AM.

It’s OK To Say No

At nighttime, you are going to get all sorts of requests. Some are important, and others are nonsense. Do not let your colleagues bully you into concentrating on peripheral activities that do not directly affect patient care. If you don’t have time to look at that tumor board case, simply say so. Sometimes saying no is just the right thing to do.

Attend To Your Study First, Then Your Colleagues

According to my previous blog, Should Radiologists Ignore The Phone?, residents pay a significant penalty when discontinuing their thoughts midstream. Error rates increase dramatically. More relevant to this post, however, the time to complete a study increases significantly, increasing your chance of causing an angry ER physician. Therefore, it is imperative that you briefly let your colleagues know that you need to complete the study first and will answer their questions as soon as you finish.

Triage And You

One of the most essential facets of the nighttime experience is learning to triage. Believe it or not, you will use these skills for the rest of your career regardless if you take call or not as an attending. What studies do you need to complete first? Who should you attend to? These are all triaging skills you need to learn to succeed. Using some basic triage concepts above, ensure your nights are shorter and safer!

Posted on October 5, 2017January 26, 2022 by Barry Julius

Radiology Swap- Radiology Private Practitioner Goes To University (Part 1)

Ever watched the show called Wife Swap? Essentially, women of two households “swap” roles and responsibilities for different families and share their experiences with the TV audience. It’s a lot of fun to watch! Like this exercise, I thought it would be fun to speculate on what would happen if you swapped a private practice and academic radiologist for a month. How would each experience the other’s world? What would be the trials and tribulations? Let’s see!!!

Radiology Swap- Private Practitioner Goes To University

Radiology Swap Day 1:

The private practice radiologist walks into his university radiology reading room for the first time. Looking around, he encounters a group of 2 medical students, one resident, and one fellow waiting for him to read out the films from yesterday evening and the morning. He thinks: Why are all these people here? Do I need four additional trainees to look at the ten cases left over? This excess is sort of ridiculous!!!

He begins to sort through the pre-dictations of the radiology resident and fellow. As the cadre of 4 trainees looks over his shoulder, he looks at the first dictation and decides to erase everything. Although he feels a little bit self-conscious from all the stares over his shoulder, he starts all over from scratch. He doesn’t like the way the resident words the dictation. It’s too freakin’ long. Rapidly, he runs through each resident and fellow’s cases, erases each, and re-dictates everything.

Only a few additional cases come through the department, and the resident/fellow handles each before looking at the images. They are tertiary referrals from another facility and are very complex, but he does not perseverate and completes the cases in 30 minutes. Staring at the clock, he begins to walk around. Well, not much going on. I’m going to grab some breakfast!!!

After grabbing breakfast for 15 minutes, he arrives back at the reading room. Two more cases show up. The residents, fellow, and student seem to wait for the radiologist expectantly. Again, he promptly erases the resident and fellow dictations and quietly reads the two cases very slowly with the team, trying to pass the time. This day is Chinese water torture! Learning to run intermittently once every few hours from his office to the reading room, the day continues, as is, until work ends at 5 PM.

Radiology Swap Day 15:

It’s the weekly admin slot. On the schedule today, the radiologist attends a tumor board with bleary eyes at 7:00 AM. Not accustomed to the so much time spent on each case, it is hard for him to stay awake. But he manages. Next, at 8 AM, he attends a meeting to discuss performance reviews for the technologist staff. For half of the conference, the attendees discuss when the next meeting will occur. Ugh!!! What a waste of time!

He quickly dots off to read a few films to help out his colleagues instead of perching himself at his desk to write a grant. He has writer’s block. What the hell should I be writing now? I haven’t written anything but a dictation for 20 years!!! He sits and sits and finally falls asleep at his desk.

Noon arrives. Thank God it’s lunchtime. Something to do!!! He happily runs down to the cafeteria to eat. He stretches out his lunchtime meal for one hour when the next meeting starts. Quality improvement initiative is the theme of the next conference. Could they think of a more boring topic to meet about?

It’s now 3 PM. He begins to meet with the backup staff in the department to discuss increasing resident and attending research output. This group includes the research coordinator, the head of research, the research financier, and the student research liaison. A recurrent thought flashes through his mind during the entire meeting. Who pays for all these extraneous people and why? I would cut the fat here immediately if I could!!!

Radiology Swap Day 30:

Assessment day! The department chairman sits the private practitioner down to summarize the events that ensued over the past month. The conversation goes something like this:

Chairman: I am impressed that you got all the work done quickly. They can be challenging cases. Our other academic radiologist never seems to get to read all the films.

Private Radiologist: Really? He only read 20 films per day!

Chairman: However, you did not apply for one grant; you did not even start on one paper. And, the physicist caught you sleeping at several meetings. Publish or perish!

Private Radiologist: Well, it’s challenging to write anything when you haven’t written a paper for over 20 years! How do you not sleep when half your meetings are about when the next meeting will be?

Chairman: And, your student, residents, and fellow claim that you rewrite all their dictations. You then grumble how they don’t know how to dictate and forget that they are there. Teaching is an integral part of academic radiology.

Private Radiologist: I don’t understand why they have to be there. They don’t do anything but stare over my shoulder!

Chairman: Although you can make it through all the films, your academic prowess is very poor. Academic radiology is not for you.

Private Radiologist: Thank God I can return to my private practice tomorrow!

See you next week for part 2!!!

Posted on October 1, 2017January 20, 2022 by Barry Julius — 1 Comment

Ten Things Radiologists Cannot Tell The Ordering Clinician (We Wish We Could!)

As residents and radiologists, we have all experienced frustrations that we cannot verbalize to an ordering clinician for fear of retribution. Perhaps, the ordering clinician may stop referring patients to us. Or, just maybe we will get written up in the middle of the night for performing unprofessionally. That would end badly! Regardless, I have created a list of ten things that all radiologists and radiology residents wish we could tell you, the ordering clinician, but cannot quite get up the nerve to do so. So, here we go.

Examine The Patient First

How frustrating is it that patients get a hepatobiliary scan to rule out cholecystitis, only for us to discover afterward that the patient had a cholecystectomy? Or, we receive a CT scan to rule out appendicitis, only to find out there is no appendix! Come on, guys, do your due diligence, PLEASE!!!

Throw Me A Bone- Give Me Some More History

You ever heard that saying called GIGO- garbage in, garbage out? Well, that certainly applies to us! Please, no more clinical histories with abnormal clinical findings or rule out? What does that exactly mean? If you want your reports to be somewhat valuable, throw us a bone!!!

I Cannot Read Your Handwriting- Write Something Legible Next Time.

Ever consider the amount of time we waste trying to mull over what you wrote on the prescription? Precious time that we could have used to get home earlier lost! Did you write CT w/ for contrast, or does CT w/o mean without contrast? This stuff matters!!!

Get An Answering Service, Bub!

Yes, there are times that we need to contact you. One of the most frustrating things in the world is to make that phone call that your patient has a pneumothorax only to find you, the ordering clinician, are out to lunch without anyone to contact. Please, please, please. If you are not around, find us someone who is covering!!!

Don’t Kill The Messenger

Hey, guys… We are only trying. Don’t get angry with us when we are doing you a service by letting you know that patient has an unforeseen pulmonary mass. Or, maybe we want to tell you that your patient has acute appendicitis. I don’t care if you are on vacation when we get you on the phone. Please show us a little bit of respect!

Just Provide The Relevant Facts, Man, We Don’t Have All Day!!!

We, too, have studies to read and patients to see. Could you not keep us on the phone? We have to hear about all the patient’s irrelevant labs, history, and physical examination. Keep it short and sweet, folks. We have lives that we would like to lead!

Don’t Send Us Your Patients At 4:55 PM!

Why do you like to send us your patients right before we are about to leave? Well, maybe, that patient with a GI bleed that you don’t want to work up because you want to go for the day. So, you send that patient for a GI bleeding scan instead of an endoscopy that you would typically do. The patient gets extra radiation, and then you delay the final diagnosis. Is that good patient care? NO!!!

We Are Not The Hospital Dumping Ground- Take Care Of Your Patients

So, your patient is giving you anxiety because he is combative on the floor. Therefore, you send the patient out to get a test so you can get a breather. Well, if you can’t handle your patients, we certainly can’t control your patient when they need to stay still. We are not the hospital dumping ground. At the very least, give your patient a valium if you send them down to our department!

If You See Us Dictating- Don’t Interrupt Us Until We Are Done!

You wouldn’t stop a surgeon in the middle of surgery. So why the heck would you want to interrupt us in the middle of our dictation? We provide essential information to our clinicians, and studies (1) show that interruption prevents radiologists from making all of the findings. Please… Appreciate what we do!

Give Us A Chance To Look At The Films Before Coming Up With A Final Opinion

So, you came down to our department to talk to us about the study you just ordered. Maybe, it is a CT scan of the abdomen and pelvis. Or perhaps, an MRI of the knee. If you know the nuances of reading these studies and you are telling us all the findings, then why did you come down in the first place? Did you do a 4-year radiology residency already? I think not. Give us a chance to make the correct diagnosis, not the one you want to tell us!

Final Words To The Ordering Clinician

We are clinicians, too, so we appreciate some professional courtesy. Do onto others as they would do to you!

http://www.academicradiology.org/article/S1076-6332(14)00307-9/fulltext?cc=y=

Posted on September 28, 2017August 14, 2020 by Barry Julius

Happy One Year Birthday To Radsresident.com!

My Birthday Balloons!

Personally, I think it is very important to celebrate momentous occasions. And for me, this is certainly one of those times! I am proud to announce that my blog- radsresident.com has survived to its one-year-old birthday. And, there are lots of folks that I would like to thank. Of course, I would like to appreciate all the authors, commenters, critiquers, email writers, and posters who have added immeasurably to the quality of this website. And most importantly, I give my heartfelt thanks to all my loyal readers who have encouraged me to keep this blog afloat.

For this post, I would like to share with you some of the statistics for the year and recount some of the sentinel events. And, I am also going to mention some of the future plans for the website.

Statistics For The Past Year

I am a lover of statistics and if you are into statistics, writing a blog is heaven. Some of you may be curious as to who reads the website, the most popular blogs, and more. So, I will give you the lowdown as of the blog’s first birthday. Let’s start at the beginning.

Over the past year from September 24, 2016, through September 23, 2017, I have had over 68,700 page views and 34,800 individual visitors arrive at my site. Out of the 68,700 page views, about 60 percent of the hits are from the United States. The other countries in the top 5 to visit my site are India (10%), Canada (2.7%), Pakistan (1.6%), and the United Kingdom (1.4%). Most countries throughout the world are also represented.

How do folks find my site? Well, 34% find my site through search engines, 31 % land on my site through social media, 30% arrive at my website directly, and 6% are referred from other sources such as Aunt Minnie.

In total, we have published 105 separate posts as of the blog’s birthday, not including all the additional pages that we have written. Of all these posts, I have authored 83 unique posts; 14 posts have been interesting questions posed by viewers/commenters in the Ask The Residency Director category; guest authors have written 8 posts.

Ten Most Popular Posts Written By Me:

Three Most Popular Ask The Residency Director Posts:

Three Most Popular Guest Author Posts:

Up To Date Book Reviews For The Core Examination by Danny Nahl, MD
Teleradiology, A Risky Business? by Haley Dezendorf
Has Technology Ruined Your Chance Of Employment In Radiology? by John Chung

Whirlwind Birthday Tour Of The Past Year

Not only did we have a prolific year at radsresident.com but we also were honored to have some of our posts published in some great blogs such as Aunt Minnie, Doximity, and PassiveIncomeMD!

Blogs Published In Aunt Minnie

Blogs Published In Doximity

Blog Published In PassiveInvestorMD

Alternate Careers And Supplemental Income For The Radiologist

Plus, we have survived one full website update and I have written a book called Radsresident: A Guidebook For The Radiology Applicant And Radiology Resident, both on Kindle and paperback. And, we have created new features that have been a great success such as Ask The Residency Director and The Case Of The Week. Of course, I am still experimenting and trying to figure out what interests you, the viewer, and what works on the website well so that I can continue to create interest, entertain, and grow the website audience!

Please Continue To Support The Website

Although our website is growing by leaps and bounds from its humble origins, radsresident.com continues to operate at loss. So, if you like this site, please continue to buy books and items through our affiliate Amazon.com in the books and links section.

Also, if you are interested in completing surveys for money, I am an affiliate of both M3 Global Research and GLG Group. I currently use both companies to complete surveys for extra cash. If interested, I highly recommend joining both organizations to maximize your survey dollars.

And finally, I am also an affiliate of grammarly.com. I use this application on a daily basis to help with correcting grammar for the website and find it exceedingly helpful. If you are interested in writing personal statements, papers, or other documents, I highly recommend utilizing it as a grammar check. Joining up is free for the basic version and you will also support the website. Just click the link in this paragraph.

The Future Of Radsresident.com

For now, I plan to continue to write lots of blogs that I hope will be useful and of interest to you, the reader. (I have 4 articles already written in advance and have lots of ideas for new articles!) In addition, recently, Doximity has asked to publish some of my new articles on its website. So, I am excited to announce that you can also expect that Doximity will highlight my articles in the Doximity op-ed section!

As we go along, I also hope to continue to get great questions from my readers to use for the Ask The Residency Director section of the blog. And, we will continue to publish interesting articles by guest authors as they come through. Of course, if you have any interest to participate in any of these ways, don’t hesitate to contact me at director1@radsresident.com!

Gradually, I also plan to experiment with what works best on this website. But, would be happy to entertain any further suggestions from you, the audience. Over the next year, you may notice changes to the website every once in a while as I add on concepts to the website that may be interesting or take away others that I find to be redundant or do not work as well. Please, I would love to know what you think! Thanks for celebrating the blog’s first birthday with me, everyone!

Posted on September 24, 2017March 2, 2022 by Barry Julius

Should Radiologists Ignore The Phone?

All told, on any given day as radiologists, we may receive tens of phone calls from our colleagues, technologists, fellow clinicians, administrators, friends, spouses, and patients. We are constantly bombarded with phone calls. So much so that I always wondered about the rate of interruption in a radiology practice. Well, I found one such paper. Confirming my suspicions, a study from Radiology Business(1) looked at 1000 minutes of radiologist observation and found that radiologists were interrupted 94 times or 2.4 minutes per interruption. That sounds about right! So, we are a specialty with lots of distractions.

Some of these distractions can be very important. Others not so much. Regardless, many of us feel obligated to pick up the phone to answer questions and resolve all sorts of issues. However, at what point does a phone call interfere with our concentration? Do these phone calls hamper our performance at the job? Should we always pick up the phone or just let it ring? Or, maybe is it worth our while to hire someone to pick up the phone for us? Let’s look at some of these issues and see if we can develop some suggestions for you, the radiologist or radiology resident, as we peruse the data.

Literature Review On Interruptions In The Workplace

Let’s start with the most general and go to the most specific. We know from multiple sources that distractions can severely hamper correct interpretations. Here are a few of those studies. The first study (2) looked at 54 students creating essays with a control group (no interruptions) and two experimental wings (interruptions during outlining or writing the paper). The authors found that writers reduced the word number and quality in the groups with interruptions.

Another article (3) looked at workers participating in a simulated submarine tracking program. In this study, the researchers interrupted the participants for 20 seconds with a blank screen. They found that the interruption significantly impacted situation awareness. These participants were significantly slower and less accurate in making decisions.

Next, let’s look at some healthcare studies. This point is where it gets even more relevant. An excellent review paper (4) looked at distractions in the healthcare environment. Two of the most pertinent studies discussed in the report included an article that found that drug dispensing errors increased by 3.42% with interruptions. Then, another article showed a relationship between surgical errors and the number of disruptions.

Most relevant to us, a paper referencing radiology residents looked at the error rate of reads. They correlated the error rate with the number of phone calls in any given hour. This study showed a correlation of an increased error rate of 12 percent with each additional phone call received on call. They concluded that telephone call interruptions might negatively impact on-call radiology resident accuracy (5).

Applicability To The Radiologist

So, how applicable is this information to us, the radiologists? Let’s take these studies to heart. We know based upon the literature above that distractions are not so great for essay writing, situational awareness, drug dispensing errors, surgical errors, and most importantly, film reading. These are activities that have a direct relationship to our daily work. I think, therefore, that these studies are directly applicable to our situation.

What Do We Do About The Phone Calls?

Now, this is the million-dollar question. We know that it is part of our job to take phone calls, interact with people, and deal with sticky situations amid our work. However, with this information in mind and the knowledge that interruptions cause problems, we as radiologists reasonably need to mitigate many distractions in the workplace. What does this mean?

Well, perhaps, we should have systems that allow other employees to field some of the administrative responsibilities. Radiologists should not be triaging phone calls. Administrators should ensure that only the appropriate phone calls get to the radiologist’s desk.

In addition, we need to be mindful of the impact of distractions on our work. And we need to make appropriate adjustments. If the phone is ringing off the hook and we don’t have administrators to take these phone calls, perhaps, we should not be trying to answer the phone when we are reading a case. Instead, we should answer the phone only when we have completed reading a study.

Summary

Based upon our whirlwind tour through the world of phone calls, distractions, and our work, we now know that phone calls are a significant issue in our workplace. Next time the phone rings, think twice before you answer it!

(1) http://www.radiologybusiness.com/topics/practice-management/quality/highly-disruptive-interruptions-cause-radiologists-lose-focus-reading-room

(2) http://journals.sagepub.com/doi/abs/10.1177/0018720814531786

(3) https://www.ncbi.nlm.nih.gov/pubmed/26314878

(4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3007093/

(5) Acad Radiol. 2014 Dec;21(12):1623-8. doi: 10.1016/j.acra.2014.08.001. Epub 2014 Oct 3

Posted on September 20, 2017February 24, 2022 by Barry Julius — 2 Comments

Ten Disastrous Consequences Of Poor Study Habits

Studying for radiology is intense and unlike anything that you have done before. If you think shirking your duties only hurts yourself, you are entirely and utterly wrong. For those of you that don’t yet get it but are willing to listen, here are 10 of some of the disastrous consequences of your poor study habits!

Harming The Patient

First and foremost, you took a Hippocratic oath at the end of medical school, right? Well, by not reading, that certainly goes out the window. Not studying well leaves you more prone to interpretation errors when reading films. Ultimately, this will affect patient care. Who needs unnecessary biopsies and increased morbidity/mortality? You don’t care about that!

Your Colleagues Don’t Take You Seriously

Notice that your colleagues never approach you for consultations on their cases and second opinions. You feel out of place. Why is that? If you read something, you would go over more interesting cases because your colleagues would have a good reason to talk to you. You may become a better film reader. Well, maybe you are not interested in films and consults?

You Go From Practice To Practice

You know this type of individual. Probably, you have seen an attending or two who do not last long at your program. Sometimes you are not quite sure why they left. But many times, they can’t interpret films well. Perhaps, if they had read and studied a bit more…

Can’t Pass The Core Examination

This statement cuts right to the heart of the first through 3rd-year radiology residents. What is a radiology resident’s worst nightmare? That they need to take the core examination twice. Why would you want to do that? Just study!!!

Difficulty Obtaining The Fellowship You Want

Your dream is to go into interventional radiology. Forget about it. You always wanted to do an MSK fellowship. No way. To get into the more competitive specialties, you need recommendations. Who will give you a good one when you have not read a lick and never attempted to change your study habits? Did you think about that?

Your Attending Dreads When You Are On Call

Have you noticed that sigh that seems to emanate from your attending’s mouth when you say you will be on call the night before his CT rotation? Well, you better get used to it! Who wants to be the attending of record after you make all those interpretation errors due to lack of reading?

No Job Connections

Finally, you graduate from your residency program. But, no one seems to let you know when that next great job is available. Why not? It is straightforward. Who would want to recommend you to a position when you don’t have the background to merit it?

Attendings Won’t Let You Perform Procedures

In interventional radiology, you realize that your colleagues are getting to do a whole lot more procedures independently than you get to complete. Why is that? Hmm… Maybe, no one trusts you to touch a patient because you haven’t read about the procedure at all!

Consults Walk By You

Have you ever noticed how any clinical physician that has a questi0n walks right by you to the other guy in the corner of the room? Well, you have established a reputation for yourself because you have not been studying the right way. You are no help to anybody. Maybe this is what you wanted- you now have less work. Congratulations!

Losing Out To The Competition

You are beginning to notice that your patient loads are dropping precipitously? Around the corner, another practice opened up that now reads studies that you don’t feel comfortable reading because you are unwilling to study and learn about the new image modalities in radiology. Your wallet begins to suffer!

Bottom Line For Poor Study Habits

Reading, studying, and continually learning are all part of becoming a great image interpreter. A radiologist cannot exist in today’s climate without these tools as a resident and beyond. Why would you want to destroy your reputation and have to deal with the ten disastrous consequences of poor studying habits!!!

Posted on September 17, 2017May 27, 2023 by Barry Julius

Gaining Recognition When The Odds Are Stacked Against You

For medical students and residents, at times, it can be tough to gain recognition for your work. I want to give you a little vignette of one uncomfortable experience with a difficult attending I had as a former medical student. Then we will discuss how to counter a poor evaluation. Although your stories may differ from mine, many of you will experience something similar as you traverse through residency.

The Background Story

I was a fourth-year medical student subintern during a medicine rotation. And my group consisted of myself, a pretty female third-year medical student, an intern, a resident, and a balding senior medicine attending in his late sixties or early seventies. The attending physician assigned us to review compelling cases that presented themselves the prior week. We were then to discuss the medical topics that arose from these cases.

First, the 3rd year medical student began to discuss a patient with severe onset of hypertension. And she went through an appropriate workup of the patient with hypertension and delved into the physiology and management of patients with hypertension. It wasn’t a bad presentation. Unfortunately for me, the attending would not stop affectionately staring at the third medical student. It was a bit creepy.

Next off, it was my turn to present. I had a great case of a patient with Histiocytosis X/eosinophilic granuloma of the spine that I thoroughly researched. I knew the case and the topic cold. Therefore, I rehearsed the presentation many times at home. So, I was excited to present. What could be wrong about presenting a rare, fascinating case I knew well?

So, I began to present the case and then went through the process of coming up with the diagnosis with history and imaging. Again, I noticed the attending continuing to ogle the third-year medical student inappropriately. As soon as I started to discuss the topic, WHAM… He shut me down by saying, “We don’t need to discuss this topic because it rarely occurs, and you will probably never see another case like this in your lifetime. What a waste of everybody’s time!”

Problems With Gaining Recognition In Clinical Education

All too often, something similar to this scenario occurs in clinical medicine, whether you are in radiology or another field. Perhaps, you are a foreign medical student, and the mentor won’t give you the time of day. Or, maybe, you are rough around the edges, and your teacher doesn’t like your personality. In all these situations, favoritism for reasons other than merit and quality often trumps a great job. No matter how you change the grading system to include milestones or different innovative ways of evaluation, bias can interfere with gaining recognition for your work. In the end, the final grade often comes down to the evaluators’ quality. (Don’t take it personally!)

At the same time, there are many positives about the experience of having learned about the topic of eosinophilic granuloma, regardless of my evaluator. First of all, in my line of radiology work, the diagnosis of eosinophilic granuloma has come up in my experience several times. Second, from my studies on the topic, I have used the information from that presentation for the betterment of my patients. And finally, the subject arose on some of my radiology board examinations, and I knew all the answers to the topic cold. So yes, there was something educationally valuable from this experience.

How Can We Align The Evaluator With The Recognition Of A Good Job?

That brings us back to the crux of this post. What can you do to get the attention of your evaluators about your quality work when they don’t want to give you the time of day? I do not claim it is going to be easy. It certainly isn’t. But there are a few workarounds.

Get What Makes The Evaluator Tick

First, ask your evaluator what it is that interests them. Now, I am not asking you to be a brown-noser, but sometimes to garner the attention of our seniors, we have to find out what makes them tick. A person like this is more apt to listen to you when you are on the same wavelength. Admittedly, in my case above, if I had changed my topic, I think it still would have been difficult to change this attending’s opinion of me. But, at least, I would have presented a case that would have been more likely to get his attention.

Defy Expectations

Next, go above and beyond the expectations of the evaluator. For instance, perhaps, I could have begun a quality initiative study to improve the outcomes of patients on his service and put his name on the paper. My story above might not have ended differently, even if I had provided the “ogler” with something distinct and memorable. But, it would have increased my chances of garnering recognition for my work.

The Nuclear Option

And finally, sometimes you need to go to the top. Things can be, on occasion, so bad that you cannot even fathom doing anything that will change the opinion of your senior. But be very careful. Heads of departments will often side with their staff before they side with a resident or medical student. So, if you use the nuclear option, ensure you have objective evidence that this person is unfair to you without trying to get your evaluator into trouble. And, also make sure that the director is willing and able to help. Sometimes, they can pair you up with someone else who can evaluate your work.

Gaining Recognition For Your Work

We all encounter people in positions of authority who may not be “fair” to their subjects. It is part of what we experience in medical school and residency and part of the real world. Most of us are somewhat sheltered from the real world through the beginning of medical school because our teachers’ primary evaluation method is exams. As we enter the clinical years and residency, evaluations become more subjective. So, learning how to successfully interact with difficult attendings who may unfairly evaluate your work is vital. Don’t be another technicality of a poor mentor. Be proactive in your education and obtain the recognition you deserve.

Posted on September 13, 2017March 10, 2022 by Barry Julius — 1 Comment

The Uncomfortable “Screenostic” Breast Ultrasound Imaging Dilemma

For those of you who have completed a mammography rotation or are beginning to practice mammography, you may notice ordering physicians prescribe a diagnostic mammogram along with a diagnostic and screening ultrasound. One example would be the doctor who orders a mammogram for a unilateral breast asymmetry with an accompanying bilateral diagnostic ultrasound. Or other times, the ordering doctor will specify to perform an ultrasound for pain on one breast. Yet they order a bilateral breast ultrasound that the patient expects to get done. One of my former excellent mammographers had called these sorts of situations “screenostic studies.” And I think that is a great descriptive name since these breast ultrasounds encompass both a “diagnostic” and a “screening” component. So, I kind of took to the title, “screenostic.” Now, I use it all the time.

Issues Behind The “Screenostic” Ultrasound

For me, I always find this situation very frustrating. You are never quite sure if the ordering physician means to order the study as a screening ultrasound. Or, did they mean for the case to be diagnostic and accidentally request a bilateral breast ultrasound? Perhaps, they were not thinking about it or did not understand the purpose of the ultrasound. Unfortunately, frequently, you will never know the answer.

So, let me give you an example of what happens when you confront the issue head-on. You call the physician to learn their ordering intentions, taking away precious minutes of your valuable time. Then, when you ask the ordering physician what they wanted, the physician often becomes indignant because it “wastes their time.” On top of this, the patient expects that they will receive a bilateral ultrasound because it is “better” than a one-sided diagnostic ultrasound. Now, they have to wait longer. And if you decide to change the order, you now have to waste additional time to persuade the patient that they need a unilateral breast ultrasound.

Bottom line. All hell breaks loose. It’s ugly. You have a mixture of undecipherable physician expectations. And the patient has unfounded expectations to complete the study. The radiologist is unhappy; the patient is angry, and the ordering physician is upset. It is a lose, lose, lose situation.

So what finally happens? Regardless of the study indication and the true intentions of the ordering physician, the technologist completes the study. It’s just a heck of a lot easier. But, it is all a waste of time and money.

Call To Arms!

I only see two potential ways out of this daily breast imaging mess. First, we need intense education for ordering physicians. In most practices, however, this road is a difficult one. It can be next to impossible to get through to all the referring physicians in a bustling business. And, referrers just want to order and write their scripts without dealing with the implications. It takes too much time to “listen” to the meager radiologist or set up an educational outreach program.

Second (and I may get a lot of backlash for this one), enter clinical decision support systems. If only a system could force the ordering physician to make a clear prescription that makes sense. Clinical decision support systems would do just that.

You may think that I am just whining and complaining. But this issue has real implications for patient well-being and daily workflow. Oh well, in the end, it is just another dilemma that occurs when the clinician controls the ordering of imaging studies instead of the true imaging expert, the radiologist. Let’s take it back!!!