Category: Resident Advice

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Vacation During Residency: Not Just A Luxury!

vacation

Have you ever worked in a typical business office setting (like the world of Dilbert(1)!)? Typically, you will see young professionals, some working but others wasting time. They make time to text, check out the internet, meet at the water cooler, or make sure to make time to go out to lunch together. If they forget something or make a mistake, perhaps an order gets delayed. No big deal…

Fortunately or unfortunately (depending on your perspective!), these experiences are foreign to radiology trainees and radiologists. We tend not to have much time for inconsequential social activities in our world. Most days, we spend reading films or performing procedures with real consequences. If we miss a pneumothorax, a patient can die. If we embolize the wrong artery, we can cause a stroke. So, we relegate ourselves to taking everything seriously. And rightfully so. But, all this takes a toll over time.

Have you ever heard the phrase: all work and no play makes Jack a dull boy? (According to Wikipedia(2), it comes from 1659!) Well, this phrase applies just as much to the radiology resident. In fact, with all this talk of burnout, each resident should follow this ancient bit of wisdom. Every person (even radiology residents!) needs some time to play. So, all this banter brings me to today’s blog topic: why vacation should be mandatory for every radiology resident.

Gaining New Perspectives

Often, residents get so caught up in worrying about studying, reading, and taking tests that they forget to appreciate the other important facets of life. Sometimes, you need to step back from the daily grind and spend time with friends/family, by yourself, or accomplish something different. Whether you take a trip to an exotic locale or stay in the comfort of your own home and get some more sleep, a vacation gives you that extra time to accomplish different activities from the usual. What better way to gain a more positive perspective on your work and life?

Improving Concentration And Energy

I don’t know about you. But, after a week or two off, when I return to work, I usually return with renewed vigor. It’s a wonder what an extra little bit of sleep or change of pace can do. And I am not the only one who says so. Study after study (2) has shown that vacation improves productivity when you return. So, don’t feel guilty you are not learning enough. Take that vacation and enjoy!

Remembering What’s Most Important

Yes, the radiology work and studying we do is critical. However, as the old bit of wisdom goes, what do people remember the most at the end of life? It’s not that they wished they could spend an extra day completing an assignment at work. Instead, it tends to be the time that you spent away with your loved ones or friends or the good times you had on vacation. So, don’t fret and take that little extra time off!

Incorporating Different Ideas To Improve Residency Experience

Finally, when you vacation, you see new places, complete projects, or think about life differently. The best ideas often come when you are not at your primary work home. (For me, that’s at 2 AM when I write these articles!) Maybe, you scuba dived in Bora Bora, completed an archeological dig, took the time to finish that extra gardening, or spent more time perusing in bed. Often, you can incorporate these “extraneous” activities into improving the residency experience for yourself when you return.

Vacation And The Radiology Resident

Vacation is not a luxury. Instead, residents especially need to consider vacation as a requirement to recharge and unwind. So, fly far away or stay home. It doesn’t matter. Just take that vacation, and your work life will improve when you return. Let others worry about work when you are on away!

(1) www.dilbert.com

(2) https://en.wikipedia.org/wiki/All_work_and_no_play_makes_Jack_a_dull_boy

 

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Creating Great Radiology Teaching Conferences: Think Like A Soloist In A Jazz Ensemble

conferences

Have you ever listened to a great jazz ensemble live? When each soloist takes his turn, he plays in tune with the melody’s key. Also, he stays with the main elements of the general theme. If the soloist deviates from the key and doesn’t maintain some semblance of the original tune, the solo sounds bizarre and out of place. Even though he must play within a particular framework, a soloist also plays a unique melody, creating something new and innovative as he goes along. Sound interesting… But what does this have to do with radiology conferences? Well, let’s get to that next.

What makes a great teaching conference? Great conferences need some general theme, similar to the melody’s key. Maybe, the conference will address adrenal masses. But, if you talk about adrenal lesions and then, on a whim, deviate by discussing brain tumors, the conference will not reinforce essential concepts about the adrenal mass. And, the trainees will not remember the important points.

At the same time, residents or faculty that give great conferences also add some unique flavor that allows the participants to make the experience memorable, just like the unique melody. Perhaps, it is an unconventional thought process or a funny joke that reinforces a concept. Maybe, the direction that the audience moves with unforeseen swerves takes them to new places. The bottom line is that teaching conferences also need spontaneity.

So, let us discuss a few simple principles about how you, too, can create a conference that maintains your audience’s attention. Based on the same principles as a jazz ensemble, we will divide the remainder of the discussion about creating great talks into two parts: how to create a theme and then learn the art of spontaneity.

Creating A General Theme

As we discussed above, the key to aiding retention is to make an overarching theme. So, how do we decide on that? There are many ways to do this. One way, take a specific organ and then divide that subject into individual topics. For example, if you are talking about adrenal masses, introduce each adrenal tumor type and find individual cases to demonstrate the appearance and pathophysiology of each adrenal lesion.

Or, you can find a pathophysiological mechanism and present cases that conform to that diagnosis. In this situation, we can take masses that cause mechanical renal obstruction. Whether you take a general subject area or pathophysiological mechanism, ensure all the cases tie into the theme. This way, you will reinforce the retention of your audience.

Learning The Techniques Of Conference Spontaneity

Just as important as creating a great theme for a lecture topic, residents and faculty all need to learn how to be spontaneous to maintain our audience’s interest. But most of us never learn the art of spontaneity at a conference. So, how can we take our talk to the next level and become more than a droning speaker?

First of all, don’t use PowerPoint as a crutch. Slides are guideposts for an idea, not a source of exactly what to say. I can guarantee that if you read your slides word for word, most of your audience will drift away. (especially residents who had a long call the night before!) Instead, talk about the general ideas behind why you created the slide as if you were conversing with a friend.

Second, let your audience actively participate in the conference. What do I mean by that? Perhaps, you want to have the audience answer multiple-choice questions. Or, have the listeners take cases under your direction. Either way, you will not allow your audience to nod off and feel like they are only passively observing.

Finally, I recommend adding relevant analogies, jokes, or stories to enliven the conference. When you think about some of the best talks, something in the lecture clicked with you to make you remember a concept or theme. Usually, one of these techniques would have helped you to retain the new knowledge.

Creating Great Conferences

Unfortunately, quality varies widely among residents and faculty when giving conferences. Often, it is not the fault of the individual that gives the lecture. Instead, faculty and residents have never learned the basic tenets of providing a great conference. So instead, think like a jazz ensemble and use the basic principles of creating a general theme and utilizing my techniques to become more spontaneous. With these tenets, you will give conferences extra spice to keep the audience engaged and increase retention of the information you present.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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When To Say No At Nighttime (A Resident Guide)

no at nighttime

Radiology residents can expect disagreement with a nurse, fellow resident, or attending on any given night. Due to lack of sleep, tempers flare, and we magnify minor problems into large ones. Ultimately, we mostly accommodate our colleagues and perform the study they request as we should! Sometimes, however, saying no at nighttime can be one of the most important yet challenging responsibilities of a radiologist on call that we need to learn. We don’t want to offend our colleagues’ sensibilities or upset the attendings of other clinical services. And we want to ensure that we complete studies promptly to increase ER turnover. Yet, there is a time in all radiologists’ careers when the right thing to do is say no.

But, at what point should you say no, I won’t comply with your request? Let’s explore this issue of when to say no at nighttime. We will discuss some of the most common circumstances for the radiologist to refuse a request appropriately. For each case, we will discuss how you should proceed instead.

Studies That Would Cause Undue Patient Risks

Out of all the reasons to refuse a study, most importantly, we must ensure that we comply with the Hippocratic oath, “First do no harm.” This oath is priority number one. For all of us, a time will come when a resident or attending will ask us to perform a study or procedure that can potentially harm the patient. It could be an unnecessary CT scan on a pregnant woman or a biopsy on a patient with an elevated INR. As a physician, we need to prevent these procedures from getting completed. It is our first and foremost responsibility.

So, how do we stop a study when attendings or residents apply crushing pressure to perform the exam? First, we need to elaborate on the data behind why such a study would harm the patient. And then, most importantly, we need to do it in a way that does not demean or upset the physician. This technique is where the art and science of medicine meet in the middle.

Procedures That Would Jeopardize Your Safety

Not only do we have a responsibility to our patients. But also, we have a responsibility to maintain our safety. To take care of others, one must take care of oneself. So, to put yourself in significant danger, simply put, clearly does not meet the sniff test of practicing good medicine. The test could involve putting yourself in harm’s way with a combative patient or exposing yourself to undue radiation. Make sure to think about your situation first before going ahead.

How do you decide if the procedure would affect your safety for you to say no at nighttime? Always think about the potential consequences of a worst-case scenario. If you can think of a situation when you can get seriously injured from a study, it is probably not the best idea to complete the procedure.

Interpretations Or Procedures That Need An Attending

Sometimes we should not complete a test or procedure unless an attending can be present. You may be able to perform the exam adeptly. But, it is not in your best interest to complete the study for legal or ethical reasons.

How do you judge if the study may not qualify as a resident’s domain? If the procedure can result in significant harm unless performed by the appropriate personnel or a protocol establishes that a resident should not complete the study, hold off and call your attending. Let’s give you an example, such as a brain death study. Although easily interpreted by a resident many times, the consequences of “missing” can result in severe harm. Additionally, many programs have protocols for attendings to read this examination.

Inadequate Resources

This one may seem pretty obvious. However, we should not promise to complete a test if we don’t have the capability of finishing it. Often, residents unknowingly will offer a solution to a problem that may not exist in your institution. Or the institution cannot obtain the resources on the night of your call. For instance, you may promise the clinician that you can perform a V/Q scan, not realizing that the agents are in short supply. Unfortunately, this disrupts management, the timing of testing, and the formation of a patient’s final disposition. So, always make sure to check that you can complete a test before you allow the order. And, make sure to let the ordering doc know!

Nondiagnostic Studies

Occasionally, you find an adamant clinician or resident who demands the immediate performance of a test that will not assist in making a diagnosis. In a huff, these folks can propel you down the wrong road. In this situation, it pays to push back a bit. How? Data is your friend. Perhaps, the clinician insists they need a bleeding scan when the patient has a very slow bleed. Calmly, you need to explain why the test would not change the patient’s situation or add any additional significant information. Usually, the ordering physician will comply.

Things That Take Up Too Much of Your Time At the Expense of Patient Care

Often, students, residents, or even faculty will ask for assistance on all sorts of studies they may need help interpreting. However, your time can be minimal. A typical example: A resident asks for a reinterpretation of a cancer workup performed six months ago. Now, it may be essential to perform at some point. But, if you have 20 trauma cases that you still have not read, is it the correct decision to look at this sort of study? Probably not. So, politely tell the resident your situation. Trust me. This physician will go away and let you interpret your STAT cases.

Repeating Similar Previous Studies Without Good Reason

Finally, it is not uncommon to find orders for a repeat CT scan or fluoroscopic study after someone has recently performed it. Clinicians sometimes make errors in unknowingly repeating studies. I can’t tell you how many times this has happened. As radiologists, we are responsible for checking and finding out if these studies are indeed warranted. Again, you must calmly and politely let the ordering clinician know if this is the case.

Final Thoughts About Saying No At Nighttime

Saying no can take real guts when you are not the “authority.” But, when to say no at nighttime needs to be learned by all residents. It can be an art as well as a science. And the lessons stay with you for the rest of your career. So, if the situation arises that you need to say no at nighttime and it can affect patient care, respond gently and with the data to prove your point. The rewards of saying no can be immense.

 

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The Mega Five: The Ultimate Resources For The First-Year Radiology Resident

Wow, what a feeling! You did it! You’re officially a first-year Radiology resident! And, you just took your first step toward the rest of your life!! One full year has gone in the blink of an eye and you molded yourself into an unbeatable intern! Your mastery of surgical knots, writing extensive progress notes, rounding, and discharging patients have you feeling like you can tackle the world! In fact, you’re so eager to show off all your skills as a first-year radiology resident to your new Radiology Attendings on your first rotation that you jump right in and introduce yourself. You find a really comfy chair next to him, eagerly waiting to learn.

So, your attending opens the very first case and you already know the answer is pneumonia. Let’s face it on those long ICU rotations when was it not? To your surprise, it’s a head CT. He then gives it a quick scroll and asks those fateful words “Normal or abnormal?” … You sit there in silence… Chills run down your spine…sweat appears on your forehead…What just happened? Uttering the word ”I” a few times, you finally commit to the full sentence “I don’t know”. You have failed. You know nothing and feel like you are nothing… At least that’s how you feel for a short while. But hey, it’s your first day!

Get used to it… In the beginning months of the first year, the phrase “I don’t know” will become all too familiar because let’s face it, you don’t know! Not a thing! As an intern, you haven’t picked up a single book relating to radiology. And, you may have only looked at the impression to relay the information to your higher-ups when needed. You just did not have the time! So? What now? Where do you turn? Who can help you? You feel smaller than an insect. How can you possibly turn this around? Get ready to take all your years of what you learned and flush it down the toilet! You’re about to enter a whole new realm, the world of radiology.

The Mega Five

Enter the Mega Five. What is the Mega Five you say? Only the five most powerful resources at your fingertips for the first-year radiology resident! Sure, there are a ton more but these have been the most help in my experience. So, let’s start!

Case review series, Case review series, Case review series!!!

I cannot say it enough but these reviews are incredible. Most importantly, you don’t need a lot of background in order to learn as you go. And, the series takes excerpts of information from the Requisites (longer and wordier than the case review series!) and summarizes the material. Each case has questions and pictures. In addition, it literally contains every subject with increasingly difficult sections as you progress within each of the books.

Core Radiology

I love this book! It contains high-yield pictures and information, especially the Aunt Minnies. And, the book goes system-by-system, image-by-image. It even gives mini dictations of how you should describe the entity.  I can honestly say Core Radiology has helped bolster all my dictations positively. With all the knowledge you attain during 1st year, this book serves to solidify and maintain a steady foundation.

Radiopedia

I can’t believe I’m saying this but yes…Radiopedia is an incredible resource. First, you get fast information, pictures you can scroll through including CT and MRI studies, differential diagnoses, and links and videos. You can also sign up for these links and videos if you so choose (I did for emergency radiology before taking call). Finally, you can think of it as an underused gem like Wikipedia for radiology but even better!

RADPrimer

Oh, RADPrimer how I love you so… RADPrimer makes the list because let’s face it… What are facts without questions to test yourself? With over 4000 questions, you better just dive in and do 10 a day because it has a UWorld feel to it. And, if you’re like me, UWorld was the Holy Bible for USMLE Step 1, 2, and 3. So, why let this opportunity go to waste? Get cracking now…  Just start RADPrimer and crank out questions. You’ll see how much you really know from your studies.

Radiology Assistant

Last but not least, we have Radiology Assistant. To put it mildly, this website is incredible with detailed information, videos, pictures, and cartoons. You name it and they have it. In fact, I utilize this website as much as possible. There are even lectures to watch that break down hard topics, an amazing bonus.

But Wait There’s More…

In addition to my top five resources, of course, there are a ton more. Some of the other resources that I have used include Felsons Roentgenology,  E-Anatomy (application), headneckbrainspine.com, and Lieberman’s eRadiology. Although I poked fun at it above, I still need to mention the radiology requisites series in a better light. As wordy as they may be, you must read them. Why? Well, I’ve noticed that the question banks gather much of their information from the requisites. And finally, please do not be afraid to use free resources like Google, Google images, and even YouTube!

My Final Thoughts

The Mega Five worked well for me during my as a first-year radiology resident because these resources were readily available and came with a wealth of knowledge. If you take advantage of the Mega Five too,  your hard work, diligence, and dedication will pay off. You too will be saving lives “radiographically” one day at a time (A catchphrase for my dating app. I am a single resident, so don’t take it, it’s mine and copyrighted!) So, best of luck to you. Remember, being a first-year radiology resident is tough but there are lots of quality resources to help you out. So, never give up!

 

 

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Best And Worst Days To Be A Radiologist On Call

worst days

Some may wonder why you always may have a “black cloud.” And others seem to work only on quiet evenings. Well, maybe the black cloud or halo you wear is more than chance. Perhaps, you sign up for the easy or difficult calls without realizing the consequences of your choices. So, to advise which days you need to consider working and others you should avoid, I am listing some of the best and worst days to be on call. Here we go!

Best Days

Snow Days

If you ever work on a day with a heavy snowstorm, consider yourself lucky. If it is a state of emergency, it’s even better. Almost no one arrives at the doors of the emergency department. Why? Because they are not allowed on the roads!!! And, if they can’t drive, getting into a bad accident becomes much more challenging. Hence, you are in for a beautiful night!

Your Favorite ED Attending’s Shift

It turns out that not all ED attendings are alike! You have found gold if you find one that rarely seems to order imaging studies. Follow this attending to the ends of the earth. And, make sure to work those calls that match this chap’s shifts!

Christmas

Although not always palatable for some, you cannot find another holiday when patients sparsely frequent the emergency room like this day. No one wants to be in-house. And indeed, no one wants to receive an imaging study. Plus, to add another perk, many hospitals give free meals to those who work this holiday. If you can tolerate working on Christmas and want an easy day, seriously consider working!

Super Bowl Sunday

For those who don’t enjoy football, this holiday will treat you to a great evening. Imagine barely hearing a pin drop in the reading room. That is usually the theme when working on Super Bowl Sunday during the game. The television tempts almost every patient and physician to watch the screen. Therefore, you can pretty much expect a quiet evening.

Worst Days

Independence Day

This holiday does not lend itself to quiet while the weather is lovely. And explosives abound. What more needs to be said???

The Hours After The Super Bowl

Call it the rebound effect—all those hours of watching delay the inevitable. Injuries and phone calls miraculously appear again out of the blue. And all that food and alcohol consumed by the celebrants… Well, let’s put it this way. Every cause has an effect. Unfortunately, if you work this time, do not expect to rest!

First Day After Large Snowstorm Is Over

Everyone returns to work after that significant snowstorm is over. Well, guess what? They have to dig out their driveways or drive on slippery roads. These activities do not come without consequence. Heart attacks, falls, and car accidents are everywhere. It’s just not a pleasant day to work!

Your Least Favorite ED Attending’s Shift

Some attendings just like to order studies. And usually, the younger and more inexperienced the attending physician working in the ED, the more studies ordered. So, beware of a shift with this sort of physician. The emergency department will inundate you until you are teeming with work. Try to postpone your call to another day!!!

Great Weather

Blue skies? Perfect temperature? You are in for a rough day! Everyone wants to be outside. And guess what? That means sports and injuries. And, you are on the front line… So? They are coming to the hospital for imaging!!!!

Summary Of The Best And Worst Days

You can’t always control when you are going to work on call. However, if you have a choice, now you know the best days to work and those to avoid. Hey… There’s nothing better than a nice quiet night when you can enjoy working at a leisurely pace and take the time to learn from each of your cases. So, plan to take call on these days and avoid the other frantic shifts if you can!!!

 

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Want To Improve During Radiology Residency? Think Small!

improve during radiology residency

A few days ago, I had an “aha!” moment that caused me to stay and listen to the radio in the car for an extra 10 minutes in the garage. In the “on-air” discussion, the presenter of the radio show claimed that to create tangible improvements in any skill, we need to learn from our mistakes and set smaller, more reachable defined goals for ourselves. We can’t look at our most impressive role models and realistically say I will be just like them without a plan of action. Instead, we need to create a specific goal with small attainable means to get there. And I believe the same holds for improvement in the field of radiology. I would subscribe to a similar philosophy for all radiology trainees- to improve during radiology residency, you need to “think small.”

Just like we cannot expect to become like George Harrison at the guitar in just a few lessons, we cannot assume that we will practice the highest-quality radiology after a few months of residency or even one year of practice. Improvement and learning occur at a snail’s pace. In radiology, like most complex fields, becoming a consummate professional is a slow incremental process. And, we shouldn’t be so hard on ourselves and our residents for not being perfect. Each one of us started without the complete set of knowledge and skills that we have today.

Allow For Small Imperfections

Residents often beat themselves up for missing an individual finding or misinterpreting a case. And, as polished attendings, some of us lose sympathy for the trials and tribulations of the resident. We emphasize the occasional miss, not the learning experience. Attendings may harp on the small mistake and cajole the resident about reading a film in the wrong way. But are these the appropriate courses of action for residents and attendings? Probably not. Being hard on ourselves because of a miss helps no one. And instead of hounding the resident who missed a finding, radiologists should be helping him realize he should be thankful to make the solitary error in a comfortable learning environment rather than as a final decision-maker.

We all need to understand, residents and attendings alike, that to become a consummate professional, we must make a few mistakes along the way. Radiology trainees are no exception.

Remember, only after correcting many minor mistakes throughout residency can the radiology trainee become an incredible radiologist. Radiology mentors should encourage residents to take those leaps of faith rather than hold back and merely rely on the Nighthawks or in-house attendings. Attendings should not throttle the innate drive of radiology trainees to think and do more. We do that by punishing rather than celebrating the small mistake as a tool for learning.

Setting Achievable Specific Goals

In addition to allowing for imperfection, residents must create learning plans focused on learning “small” individual skills to improve, not generalized goals. What do I mean by that? Outline the specific topic areas you want to learn and the resources you will need to cover the material. Don’t just say I will learn all about nuclear medicine this month. Be specific about the how and what. You will never reach the end goal if you don’t set a plan that emphasizes the small stuff. The ability to build upon small goals block by block eventually creates incredible professionals in any field.

Want To Improve During Radiology Residency: Think Small!

The overall completion of generalized tasks does not make a radiologist great. Instead, it is the sum of learning from our mistakes and completing “small” goals over time. So, let us all celebrate the “small.” Ultimately, the sum of “the small”corrections of imperfection and achieving specific milestones builds great radiologists.

 

 

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Phone Etiquette For The Radiologist

phone etiquette

Back in the day, I remember my former program director/chairman at Rhode Island Hospital, Dr. John Cronan, lecturing on the basics of the business of radiology. (if you’re reading this, I bet you’re impressed that I remember!) He mentioned the three A’s of maintaining a good radiology practice: affability, availability, and acumen. And, after all these years, I still take this to heart. Good phone etiquette also fits into the equation of the three A’s. It is one of the keys to maintaining a quality practice to entice repeat customers, fellow referring physicians, and patients.

And the rules apply not just for standing phones at your practice but also for cell phones too (We are not living in the 1980s, folks!) With the tens of thousands of phone calls, you will receive over your lifetime, the concepts behind good phone etiquette remain the same. So, let’s go through each of these threads to guide you on how to approach the phone.

Availability

Let’s address the most controversial area first. How can we be available by phone most of the time when I create a post such as Should Radiologists Ignore the Phone? Well, it creates a conflict of interest. We do need to make sure that we concentrate on our films first and avoid errors. On the other hand, it does not mean that we should ignore the phone. So, how do we solve this dichotomy? If you are not actively reading films, always pick up the phone. And, if you cannot pick up the phone now, at least you can promptly return messages that you may receive from the secretary or your voicemails.

If a clinician can never get through to you, you know where their business will go- down the street to the other guy! So, allowing your clinician to contact you is of the utmost importance.

Affability

Affability implies more than picking up the phone and being friendly. It also means an air of professionalism. What do I mean by that? If you are picking up a phone in a particular location, let your caller know they have reached that specific destination. So, if you are in CT scan, you may say Your Hospital, CT scan, Dr. X speaking.

Like us, clinicians run short on time, and we must respect their demands. They may arrive on your line through an operator, unsure of their destination. Taking the time to announce exactly where and who you will go a long way to establishing a rapport between you and the referrer.

In addition, treat your referring physicians on the phone as if they were a friend, not just another burden of the day. Even if it is 4:55 PM and you are about to leave the department, don’t be curt on the phone. Our referrers are the lifeblood of a radiology practice, so creating a relationship between the radiologist and the clinician is crucial. In the end, we need to develop friendships, or else why should the clinician refer patients to you instead of his friendly radiologist down the street? (We live in competitive times!)

Acumen

Finally, just as you treat any consult, on-phone or in-person, we need to ensure that we do our best to solve our referrers’ questions. Be direct. Make sure to answer any questions that you can answer correctly off-the-cuff. And, if you don’t know the answer at the moment, you can always look up the information and get back to the clinician. It is our responsibility to help our fellow doctors. That is just part of our job.

It is also awe-inspiring when you can give a source or a paper to your referring physician documenting why you think your recommendation is correct. It goes a long way to show that you keep up with all the literature. Additionally, it makes it more likely your referrer will return the next time.

Final Thoughts About Phone Etiquette

Many radiologists may dismiss phone etiquette as an extraneous part of our practice that is not worth their time. But, I beg to differ. Instead, it is an essential part of an excellent radiology practice. It is how we connect with our referrers, make friends with our fellow physicians, and direct our clinicians to the next step, whether ordering the appropriate test or solving a diagnostic dilemma. So, make sure to follow the rules of the phone!

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Top Eight Advantages Of Living Close To Work As A Radiologist

close

Driving 50 miles to and from work or over 1.5 hours each way is undoubtedly a recipe for a problematic residency or career. (I did that for six years as an attending!) So, I recommend that you heed the following advice. Live close to the hospital and enjoy life! We will go through eight tangible benefits I have discovered now that I live close to work to support this argument. Try to do the same!

Traffic And Stress

Arriving at work after a school bus, a large white van, and a Toyota Prius cut you off during your 1.5-hour journey versus stopping at the one traffic light between my house and the hospital. Which one is more stressful? Hmmmmm… I can say that stress levels have declined by 95 percent at the beginning of the workday. Who cares if that guy in front of you cuts you off in the parking lot when you are five minutes from the hospital. You’ll still arrive on time!!!

Forgetting Things

The feeling of forgetting something important halfway through a 1.5-hour journey still sends shivers down my spine. I can still remember filling out the medical staff renewal forms due the same day, only to discover they were not in the car halfway through my trek to the hospital. If that happens now, no big deal. I just go home in the middle of the day and pick it up!

Healthier Lifestyle

All those hours on the road wreak havoc on your body. The body should not sit in a car for 3 hours a day. Fast food outlets become your friend. Fat accumulates in the wrong places. All that time that you lose, you can spend exercising or creating a healthier lifestyle for yourself.

Taking Care Of Things At Home

Occasionally, you need to drop off something at the house. Or, you may meet with a contractor to fix your ceiling leak. When you are 50 miles away, it is next to impossible. On the other hand, if you are right around the corner, you can usually stop by for a moment!

Community

Are you volunteering for the community? No problem. Want to coach a kid’s baseball team? You can manage it. Join a local symphony? It’s possible to find the time. Living close opens up many local opportunities you would never have otherwise!

Emergencies

Sometimes disaster strikes. When you live far away, it is almost impossible to help out. On the other hand, if your child injures a leg playing soccer or falls off a horse and you live right near the office or hospital, you are no more than a few minutes away. You can even pick him up and drive him to your hospital yourself!

Family Time

Want to spend quality time with the kids in the evening? You will now have the time. Think it’s essential to go on date night with your spouse? It’s possible to make plans, even during the week. Need to plan family outings- like the school picnic or that hockey game in the evening. Not a problem!

Call Issues

Have to reduce an intussception at 3 AM? At least you are around the corner. You can get in and out in minutes. And, before you know it, you are done. Need to check a scan because the internet froze? All you need to do is drive-in for a moment or two, not 1.5 hours!

Live Close To Work!

As you can see, living close to the hospital makes a world of difference. And the advantages are almost endless. So, go ahead and try to live reasonably close to your work. You can live your life the way you want while not burdened by all the time wasted in the car!

 

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The Isolated Specialist

isolated

No, this is not another article about physician burnout. Instead, today we will talk about why isolated specialists can lead to poor patient outcomes. So, why do I find this interesting? In my own experience, I have encountered multiple instances when I see isolated specialists as the cause of deficient patient care. Let me give you an example.

A radiologist will encounter a non-radiologist physician demanding that his patient receive unwarranted intravenous contrast for his CT scans every once in a while. What is the big deal about administering unwarranted intravenous contrast on CT scans? Well, say you perform a contrast-enhanced CT scan for a pulmonary nodule. Or perhaps, you decide to approve a contrast-enhanced CT scan of the abdomen to check for a retroperitoneal bleed with contrast while on Coumadin. The patient risks returning home with a “present”- acute renal failure in both situations.

Meanwhile, both CT scans would give you the same result regardless of whether we administer intravenous contrast. And both of these cases of acute renal failure are entirely preventable. If you perform the study as directed by the physician, you have complied with the order as the radiologist. Unfortunately, these cases can lead to a lawsuit that you have no hope of winning.

Poor Communication And The Isolated Specialist

So, what does this all have to do with the isolated specialist? The ordering physicians decided to order CT scans on their patients without consulting with the radiologist in both cases. Sometimes these orders can go through the system without the OK of the radiologist. And in both situations, communication with the radiologist could have prevented unnecessary contrast administration. Or in other words, lack of communication/isolation between the ordering specialist and the radiologist was the proximate cause of a bad patient outcome.

All this brings me to discuss the topic of today- the isolated specialist. I will divide it into two different sections: What are the effects of operating “in a bubble” isolated from our colleagues? And how can we prevent physicians from working in isolation from one another?

Effects Of Operating “In A Bubble”

Untoward Side Effects

Witnessed in the examples above, two patients that should have had a non-contrast scan instead had their scan “upgraded” to an intravenous contrast-enhanced CT scan. Instead, a simple phone call from the physician could have prevented the possibility of a bad outcome. And these examples are just the tip of the iceberg. Many other cases exist where the clinician could have communicated with the physician and prevented a bad outcome.

Increased Expense

Imagine how much expense inappropriate imaging costs both the insurance company and the out-of-pocket expenses to the patient. It’s not just the additional unnecessary contrast. Instead, it is the additional weeks spent in the hospital, blood draws, nurses, physicians, and on and on. The physician could have avoided all of that with a simple discussion with the radiologist.

Prolonging Workups And Hospital Stays

In our example above, it is not just the untoward patient side effects and unmanageable expenses incurred. Instead, it is also the increased time the patient may need to stay in the hospital to figure out the patient’s disease entity. Very few patients say, “I have renal failure.” Patients may experience fatigue and other nonspecific symptoms. And a physician has to work up the clinical situation. Imagine the loss of time from work or other productive activities incurred by the patient and doctor.

Also, this is just one example. Lack of communication between radiologists and specialist cause all sorts of problems. Ridiculous unnecessary workups often ensue, wasting everyone’s time.

Radiologist Lawsuits

Don’t forget about the potential for lawsuits. All the factors from the above situation meet the criteria to allow a legitimate case. These would be breach, causation, and damages:

  1. The radiologist administered intravenous contrast inappropriately, breaching the standard of care.
  2. Contrast administration is the proximate cause of the patient’s renal failure.
  3. The patient suffered damages, including renal injury and a hospital stay.

A simple discussion between the physicians could have prevented a lawsuit.

Remaining Ignorant About Alternative Diagnoses and Treatments

Frequently, I learn about many of the most up-to-date patient diagnostic tests and treatments when I pick up the phone and discuss a case with a clinical colleague. In the situation above, a simple question about contrast could have avoided causing harm to a patient. This example is one where the ordering doctor remained ignorant about alternative methods of diagnosis (a non-contrast CT scan) when no communication ensued. Isolating oneself from phone calls with the specialist often prevents the best possible patient outcomes.

How Do We Prevent The Specialist Isolation?

Make It Easier To Contact Physicians

I think we have to blame both the ordering physician and the radiologist in these situations. Many physicians make it next to impossible to contact them by phone. Likewise, I know many radiologists who shun the phone under all circumstances. We have to make a conscious effort to make ourselves more available. Perhaps, it is a simple answering service that can solve the problem. Or, a radiology assistant may do the trick to improve communication.

Remember We Don’t Know Everything

Sometimes, we need to remind ourselves that each of our own experiences by ourselves is extremely limited. Only our interaction with others can allow us to understand patient issues best and give our patients the best care possible. We need to remain humble and ask for help from the radiologist and the ordering physician.

Computer Guidance

I hate to say it. But, clinical decision support systems have the potential to increase communications between clinicians and radiologists. When the computer detects the potential for a wrong imaging study order, it will force the clinician to interact with the radiologist. Potentially, this can relieve some of the issues of specialist isolation.

Attend Physician Friendly Events (Staff Meetings, Golf Outings)

Finally, many say that interdepartmental physician functions are unnecessary. But, I cannot disagree more. Making ourselves feel more comfortable with our colleagues allows physicians to be more likely to pick up the phone with a colleague who can become a friend. What better way to decrease isolation than sharing fun events with our colleagues?

Final Thoughts About The Isolated Specialist

Radiologists and specialists need to treat specialist isolation as a severe barrier to good patient care. And unfortunately, isolation is all too common. So, we need to make inroads to break down these barriers. Reducing specialist isolation will prevent patient side effects, reduce hospital stays, lessen patient expenses, decrease lawsuits, and increase diagnostic and treatment options. As specialist physicians, let’s all make a concerted effort to solve this critical problem together.

 

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Addressing Referrer Psychology In The Radiology Report

psychology

What are the most important differences between most resident and attending reports? Residents’ dictations tend to be one size fits all. On the other hand, the attending will usually look at the referrer’s name and specialty before starting with a dictation. Then, he integrates referrer psychology into the report. And finally, seasoned attendings will approach a dictation as a solution to the specific clinician’s problem.

Why is it important to address these differences? The primary reason for radiology’s existence is to provide solutions for our fellow physicians to come back for more. So, we must satisfy our referrers’ needs in our reports before anything else. And therefore, we need to individualize these solutions in every dictation we complete. For today, I aim to teach how residents and even junior radiologists can change their “one size fits all” reports into a report with a laser-like focus that answers the referrers’ questions. Let’s do just that!

Addressing Pertinent Positives And Negatives

Take a look at a great radiologist’s dictation. If the patient has a history of an abdominal aortic aneurysm, you will see statements about dissection, rupture, mural thickening, or ulceration. Or, if the patient has prostate cancer, the dictation will detail the sclerotic osseous lesions, iliac and inguinal nodes, liver lesions, the prostatic bed, and pulmonary nodules. You are much less likely to observe these relevant findings in the resident’s dictation. It is more likely to be a bland checklist. Addressing the pertinent information goes a long way to addressing the psychology of the ordering clinician.

Keep In Mind What The Referrer Wants To Know

Typically, the first paragraph of the findings should answer the clinician’s question. Logically, this makes sense. The clinician most likely analyzes only the first part of the findings and impression, if any. In addition, make sure to start with those items that contain the most critical information—then run down the findings in order of importance. For the clinician reading the report, the priority order clarifies what is most important. Dissimilar to the typical resident dictation, its goal remains clear, to answer the clinician’s question appropriately.

Give Some Leeway To The Referring Clinician

A clinician does not like to be hemmed in by the requirements of the report. So, make sure to give the clinician that leeway. Do not lock in on one diagnosis, forcing her to pursue that avenue. What do I mean by that? I will give you two examples.

First, give all the relevant likely diagnoses. If you start talking about something in-depth that is unlikely to be the cause of the patient’s illness, in essence, you may force the hand of the clinician to pursue the wrong diagnosis to the cost of poor patient care and expense to the system.

Second, you can legally bind the clinician to perform an unneeded procedure if you recommend a biopsy without an alternative. If for some reason, something goes awry and the doctor does not pursue that avenue, legal consequences can follow. So, be careful what you say!

Don’t Leave The Referrer Hanging

I like to call this waffling. Instead of giving many differentials, make sure to come down on those most likely to be the diagnosis. Always attempt to attach probabilities to the different possibilities. This process makes it much easier for the physician to provide appropriate testing and quality care.

Ask For More History

You may think the clinician will get annoyed if you ask him for more information. But, it is usually the opposite psychology. It shows you are taking the initiative. And, you are more likely to create a relevant report that will be helpful to the patient and the clinician. Rarely does a good history ruin a report!

Communicate The Results More Effectively

After you complete the report, check it over multiple times. Few things bother the referrer more than reports with incomplete, unintelligible sentences. Perhaps unwillingly, you leave out the word “no” somewhere in your dictation. Believe it or not, this can be crucial to the clinician’s treatment plan. Most of the time, the unnecessary phone calls I receive are for the occasional grammatical or incidental mistake in the dictation. It happens to everyone. But, try to minimize this effect by checking your work!

Summary On Addressing Referrer Psychology

To create a sound report that helps the clinician, you need to get into the mind of the ordering doctor. So, think like a clinician. Put all the relevant information into the dictation without the fluff, always keep in mind the goal of the ordering doctor, make sure to give some leeway to the physician, get an appropriate history, and make sure you look over your report so that it makes sense. Not only will the referrer appreciate your dictations more, but your patients will receive better care too!