Category: Resident Advice

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Good Radiologists Are Like Car Salespeople- Make Them An Offer They Can’t Refuse!

car salespeople

As I was on the phone with a colleague trying to convince the referrer of why I think a patient has Paget’s disease instead of metastases, I described the cortical thickening of the iliopectineal line and the lack of activity on the bone scan at the site and elsewhere throughout the body. And I mentioned the MRI was nonspecific, with some expansion of the ilium that went along with the case. The retort was that the alkaline phosphatase level was not high. And to that, I added that Paget’s disease in the chronic phase often does not demonstrate elevation of this enzyme. All this back and forth was to get my colleague to buy into my conclusion that the case was Paget’s disease, not metastases. At this point, I realized my job at that moment was just like all the other car salespeople I know! And allow me to tell you why.

After looking at and synthesizing all the images and analyzing other less definitive dictations and reports, I incorporated all the information. Then, my goal was to package all the data into one convincing deal- an offer the physician could not refuse, just like the car salesperson trying to get us to buy a car. So, how can we, as radiologists, convince colleagues of what we see, just like car salespeople persuade us to buy cars?

Give All The Evidence For Your Convictions

Like in the case above, I gave this referrer all the reasons why I thought the osseous lesions were not metastases and instead Pagetoid. This tactic is no different than that of used-car salespeople. They will try to persuade you to buy a car by explaining why it satisfies your needs. It’s safe for kids, has Apple Play, reliable ratings, etc. Does this technique sound familiar? Did you ever think radiologists and car salespeople are so similar?

Definitively Lead The Referring Doctor Toward The Correct Treatment Goal

Using more absolute terms can lead our referrers toward the correct diagnosis and, ultimately, the proper treatment for the patient. Avoid using equal probabilities and weights in our speech and our written descriptions. We can almost always come up with a likelihood for one or another diagnosis. Make sure to relay that information to our referrers. Also, try to eliminate words like “appears,” “maybe,” and “cannot exclude” from our communications. Rarely are these terms practical. And these words connote insecurity, not the message your clinician wants to hear when trying to determine what to do next. Likewise, if car salespeople told you the car might be safe, you probably would not be too interested in it. But if they told you it is the safest car on the market, that’s another story!

Be Convincing In A Nice Way, Just Like Car Salespeople

We may sometimes feel like the referrers are dullards (and it might be true!). Nevertheless, it is critical to relay our issues in a way that is not aggressive or toxic. Talking down to our colleagues or yelling at them will not get the point across as well as a friendly conversation or chat. Likewise, it never pays to put provocative subjective terms in our dictations as these are legal records for the patient. You certainly don’t want negative phrases like these to be present when you are involved in a lawsuit; it doesn’t make you look too professional! Car salespeople need to do the same. They may secretly hate you, but they must be nice to make the sale!

Radiologist As Car Salespeople- Make Them An Offer They Can’t Refuse!

We, as radiologists, rarely realize all the roles that we play in our organizations. And excellent radiologists need not only to make the correct diagnoses but also to play the role of salespeople. We need to give all the evidence, lead definitely, and be nice to our colleagues to persuade them about the final disposition and diagnosis. In a way, we are no different than car salespeople that need to make the next sale. We must convince our colleagues just as they would need to persuade their customers to buy a car. But, I would like to think that we also use extensive training and depth of knowledge (more so than a car salesman) to get to the point of excellent patient care!

 

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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!

 

 

 

 

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Overcoming Radiology Research Writer’s Block

writer's block

For some residents, coming up with great ideas for radiology projects may seem next to impossible, especially when starting. Maybe you are less than a year out in training and don’t know where to begin. Or, perhaps, you are just unsure how to come up with excellent ideas that the journals will accept. Regardless, given that I have written extensively on this blog and written multiple papers, let me tell you how I find ideas that will work and interest your audience. Here’re some of the basic techniques I use to overcome writer’s block!

Have A Writer’s Mentality

If you are not hunting for ideas during the daytime when you are working, you will not find the next great project. Whenever I look at an interesting case or have a great discussion, I will think about whether there is some way to make it into an article or a great project. My philosophy is that the best projects are those that fascinate me or cause me significant irritation during the daytime. Maybe, you are very interested in a particular procedure or topic that will often spark your interest in a project. Or, if you notice a problem with the institution- that could be a safety project. Constantly keep an open mind, and you will easily find many potential ideas for your following excellent paper!

Keep A Record Of What You See

Nowadays, almost everyone walks around with some form of a cellphone. You can quickly turn that device into a mini-journal. Whenever I talk to residents or am sitting down looking at images, in the back of my mind, I will write down ideas and cases that I think might work for the following article. It could be an interesting comment, thought, or case study. Regardless, write it down. Often, you can convert that thought into something more substantive later on. But keeping a record is always an excellent starting point. If you don’t write it down somewhere, you will forget about it later.

Contact Your Mentors To Avoid Writer’s Block

Whether it is your fellow chief resident, faculty, or chair, let them know that you might have an idea that will work for a journal article or book. Bounce the idea off your colleagues. Many have been through the process numerous times and can guide you to take an angle you might have thought about before. Or, they may say that others have already pursued that idea. Your mentors will know best because they have been through the process many times before.

Also, your mentors can guide you toward other folks that may be able to help you with the process. Perhaps, your institution has a statistician that everyone uses. Or they may have some research coordinators. All these individuals can help you along the way to hone your ideas.

Find An Angle

Maybe you have already come up with a great idea but are not sure how you will put pen to paper. In this situation, I usually like to think about how the topic would not only interest me but would catch the attention of others as well. You could twist or reverse the idea by taking a fresh approach. Many ideas die, not because someone else has already pursued them but because they have not taken a new direction. Perhaps you can look at it from a different population standpoint, more significant numbers, or even by adding other possible associations. All these add-ons can lead to something fresh and new from what researchers have already done.

Overcoming Radiology Writer’s Block!

Maintaining the proper mindset and creating a system is the key to overcoming writer’s block. Simple processes such as keeping projects in mind, writing ideas down when you have them, contacting others who can help, and thinking about a different angle are simple ways to prevent writer’s block from creeping up on you. These are the systems I practice every week when I write this blog (approaching 500 articles!) and they also work for creating research studies. So keep this advice in mind, and you will become a prolific writer too! 

 

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Don’t Let Significant Life Events Interrupt Residency!

significant life events

Many of you are guaranteed to have significant life events during your four years. Marriage, family crises, car accidents, and sickness are all part of life. And a four-year period of time is a large enough amount for something huge to change in your life. But, with the daily grind of residency, all these life events can become significantly more complicated. Who has time to be able to leave work at a moment while you are dealing with of myriad of possible life issues? So, what are some of the primary steps you can take to prevent your life from interfering with your work? How can you make sure to preserve your integrity within a radiology residency while these events happen during your radiology residency? Some of these obligations seem like common sense, but this is an excellent checklist for radiology residents. These steps can be easy to forget when life throws you a curveball.

Notify Relevant Faculty

You may be in an uproar because of a challenging event. However, most of your faculty will be understanding. If you are not going to be around because you need to go to court or a funeral, most faculty and attendings will understand. Additionally, you won’t be leaving them in the dust when you don’t show up for work at that time.

Get Coverage

By that same token as above, if you are not going to be around, try to find someone that can take your place if you need coverage for whatever rotation you are on. Now that you are a resident, you need to take responsibility for your actions, and getting coverage shows that you can handle the job.

Find Times That Don’t Interfere With Patient Care

OK. It is certainly not possible to change the time of a funeral. However, you can usually make many critical phone calls, heated conversations, and necessary appointments at times that don’t interfere with patient care. It is merely polite and appropriate to do so. Imagine you were the patient on the other end listening to a personal phone call from your doctor. That whole situation could be a bit embarrassing.

Try To Plan Events With Significant Notice

You can plan some significant life events with notice. Marriages, engagement parties, and meetings to discuss a will don’t have to occur in the middle of a typical workday. Try to plan these events well in advance, so they don’t have to interfere with your training and patient care.

Don’t Assume Everyone Knows Your Significant Life Events

When you are stressed out, not everyone may appreciate your situation. If you feel comfortable telling your colleagues and staff what is appropriate to divulge, let them know what is happening. Most folks will have some empathy for what you are going through at the time. It may even bring you closer to your residency. Most residencies are kind of like a family. Conflicts can arise when people in the family don’t know the issues.

Stay At Home If It Is Needed

Especially nowadays, since the beginning of the COVID pandemic, most faculty have become more sensitive to the issue of staying home if sick or can’t function appropriately at work. And, every once in a while, there is nothing wrong with taking a mental health day. If it makes you able to come back to work soon with renewed strength and attention, it may be worth the day or two that you need for yourself.

Dealing With Significant Life Events During Residency

Four years is a relatively long time to be anywhere, let alone a residency. And personal disasters and happy life occasions/milestones are destined to occur. Some of these events will distract you from the focus of your training. Nevertheless, try to mitigate the effects by following some of these guidelines. Simply telling folks the issues, getting coverage, and finding times to take care of business can make a difference. Following these guidelines allow you to look responsible. And they are ways to ensure that your residency will run more smoothly and without bogging you down with miscommunications and problems during radiology residency. Life interruptions don’t have to ruin your residency experience!

 

 

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Top Ten Signs You’re Not Ready For Call

ready for call

Last week we discussed the Top Nine Signs You Are Ready To Take Call. So, I figured I would not do justice to the topic of being ready for call without also creating a list of those signs that you might not be ready to take radiology overnights. Therefore, I have dedicated this list to those that think they are ready but are not. Maybe this is you? Check it out if any of these signs apply to you!

Never Double Checks Anything (Anything Goes!)

Our words matter, and anything that you say, the ER can use against you later on. If you recommend another test, guess what? You will probably get that test the same night! So, the resident who never checks their dictations to make sure everything makes sense and is corrected is in a world of hurt.

Anger Management Issues

If you constantly fight with your fellow residents or, even worse, your faculty, you probably need to settle down a bit before taking overnights. Ready residents can control their anger and not take it out on others because they know what they are doing. If you are in the former category, think about why that is!

You Repeat The Nighthawk Dictation Verbatim

If you rely on the nighthawk dictation as a crutch, it probably means you are not ready to strike it out on your own. You should go through every case as if it is new, even if another radiologist has already dictated it. You never know what they are going to miss. And, you certainly don’t want to miss the same things!

Never Looks Up History/Priors/Call For More Information

If you think you know it all and don’t ever need additional history or the need for priors, you are in for a rude awakening. The number of findings that you miss will be incalculable. And, you will miss the point of your imaging studies more often! It is one surefire way to mess up your cases at nighttime!

Assumes The History Is Correct And Relies On It Explicitly

Using history as a crutch is an elementary mistake that can lead to disaster. I can’t tell you how often the ER calls for hepatobiliary scans to rule out cholecystitis, even though the patient doesn’t even have a gallbladder! We need to check and recheck our work and compare it to priors to ensure we are doing a good service for the patient!

Disorganization And Routinely Forget Cases

If you forget to read films or complete your work during the daytime, do you think you will remember to finish everything at nighttime? Disorganization can lead to disaster. You can wind up dictating the wrong case on the wrong patient if you don’t watch what you are doing. So, get yourself into shape before starting!

Cannot Get Through The Daytime Cases on Time

It’s not just accuracy that matters at nighttime. Speed is critical as well. And, if you cannot get through work during the daytime, what makes you think you will get through everything at night? Cases will often come in batches, and everyone needs a timely report when this situation happens. Make sure that you are up to the task!

Only Knows The Aunt Minnie Diagnoses And Never Scrolls Through Cases

There is a big difference between knowing the diagnosis based on a solitary image and having to make your finding on an entire case that has hundreds of pictures. If you think you can get through your studies without the experience of scrolling through lots of cases, you will have lots of problems when you have to make all the findings at night.

Unintelligible Dictations

Do your attendings always tell you to edit your dictations because they can’t understand what you are trying to say? Well, listen to these folks very carefully. Dictations are the final product of what radiologists do. And, if you cannot say something intelligible, you have no business being on call!

Lack Of Rigorous Search Patterns

Every resident needs a rigorous search pattern when they are working at nighttime. Lacking a search pattern is a recipe for missing all the critical findings. If you never look for the spleen, you will never know it is absent. And so on. Hone in on your search pattern skills before starting to take call!

Are You Not Ready For Call Yet?

If one or more of these signs describes you, you may not be ready to take your first call. However, there is still a bit of time. So, go ahead and make adjustments before it’s too late!

 

 

 

 

 

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Top Nine Signs That You Are Ready To Take Call

take call

Are you wondering if you are at the level of a second-year resident, ready, able, and willing to handle overnight shifts independently so early in the year? Here are the top nine ways you know if you are prepared to take call!

Methodical Thinking/Search Patterns For Each Imaging Study

Do you have a search pattern for every case you attempt to tackle? When reading a CT scan, you should have the same search pattern for every study, including abdomens, necks, heads, legs, and more. Do you have a specific way you approach each of the sequences on an MRI? This approach is the minimum for starting as a resident on call!

Know When To Get Help

If you are not sure about a finding, what do you do? To answer this question, if you are ready for overnights, you will not blurt out the first idea that comes to your mind. Instead, maybe you will contact the ER physician to get more information or do a google search. Knowing when you don’t know something takes maturity and poise.

Don’t Get Too Shaken By The Mob

It’s always tough when you have a team of tired surgeons hanging on your every word. And they want a STAT read yesterday. Nevertheless, you have the confidence to plow through any case with a stream of eyes and ears watching your every move. They will have to wait until you are ready to give them your impression!

You Know All The More Common Disease Entities And Findings That Will Kill Patients Or Cause Severe Morbidity

If you can make the findings of a patient with diverticulitis, aortic ruptures, bleeds, pneumothoraces, and more, you are more than halfway to your goal of taking call. When taking cases independently, these entities should be on top of your mind. And, you should be actively looking for them when you take any study. Those that do will be unlikely to make any significant misses!

Can Tell Normal Versus Abnormal Fairly Quick

When you have seen enough cases, your brain can tell if an image is normal or abnormal before you can verbalize what the problem might be. You have already trained your brain to know what the general findings of a normal case should be. Therefore, you can look at almost any study and know that you should pursue it further if you assess it as abnormal!

You Make The Findings Before Your CT Attending Does

This one is not a requirement. Nevertheless, it is a good sign. If you can make the findings before your faculty member does, you have already been preparing for the time you would start to take calls. Kudos to you!

Notice A Sigh Of Relief When Your Attending Knows You Are On

Knowing when you are wanted can take a bit of emotional EQ. But, if you notice that your attending’s blood pressure drops by a bit and calms down when you arrive in the morning to work on the day’s rotation, this is generally a good sign. You have your faculty trained to know that you do good work.

You Get Phone Calls From ER Physicians To Ask Your Opinion

You are probably doing a fabulous job if you are getting phone calls asking for you by name because they like your reads. Most ER physicians will not actively seek out a junior radiologist instead of faculty to see what you think. You should be honored that they respect your judgment!

Seasoned Technologists Actively Look For You During The Day

Yes, technologists do know a lot. They most likely have been in the same job for years and have seen many cases. If these folks actively seek you during the day to get your opinion over others, you probably know a thing or two. That’s the ultimate compliment!

Are You Ready To Take Call?

Don’t worry if none of these statements pertain to you early in the year. You still have a bit of time. However, try to make some of these signs your goal before the start of your first call. At that point, you will get the hint that you are ready!

 

 

 

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How To Keep Tabs On Incomplete Radiology Studies

incomplete radiology studies

At least once or twice a week, there are some incomplete radiology studies that you can’t read at the moment. Perhaps, the referring physician is not available to go over the results. Or, maybe the study has a technical issue before you dictate it. Other times, it’s a challenging study you want to share with your colleagues to get another opinion. 

You must complete these cases in any of these situations, but an issue or two prevents you from getting to them. Dropping the ball on any of these cases can lead to problems in the future. So, what is the best way to remind yourself to complete these tasks and finalize them? Should you use electronic or written materials for this task? Let’s go through some options some radiologists deal with some of these issues. Hopefully, this piece will help you to come up with a system as well.

Using Your Memory

For most of you, this technique would be the one I would avoid using alone. It’s a recipe for disaster unless you have a photographic memory you can turn to at any moment. You will most likely forget the critical information you need to look up the patient information and forget about the case itself.

Keeping Cases On Paper

Some real old timers I know kept a list of these critical cases in a tiny notebook they used to whip out at times. I know a few that would swear by this technique. They would typically write the name of the patient, the MR number, the date of birth, the phone number and name of the clinician, and the issue with the case itself. One of the most significant advantages of using a system like this is that you don’t have to worry about HIPAA violations if you keep the book safe. No one can access the patient data except for you. However, if you lose that book, you are SOL. And, it is easy to forget to come back to these patients.

Keeping Incomplete Radiology Studies On A Phone In Notes/Reminders

This method is the primary way I remember to take cases needing further involvement. I will put the patient information in a locked notes folder on my iPhone. And, I typically write down the information I will need to return to complete the case. By doing this, I know that I have all the information for the patient, safe and sound. Additionally, I check these data lists daily to ensure that I do not forget their further workup. If there is something that I need to take care of more urgently, I will typically serve myself a reminder as well to complete the task at a specified time/date.

Using The PACS System To Help You Out

Finally, some PACS systems have features that can help you with these errant cases. Some have instant messages for tech recall issues. And others have automatic messaging of critical findings. At our institution, I will typically tag my name to a study so that I will continue to see it on the worklist until I do the task. This method is another fail-proof way so that cases do not slip through the cracks. But, I recommend you look into some extra features on your PACS system that can help you a bit!

How To Keep Tabs On Incomplete Radiology Studies

We need practical tools to remember to complete delayed cases. Dropping the ball and forgetting about them is a recipe for disaster. So, find a way to recall these cases that work for you. Whether it is paper, notes/reminders on an iPhone, the PACs system, relying on your memory, or any combination of the above, make sure you have a plan in place. Some cases need the extra love!