Category: Resident Advice

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Should I Attend The Radiology Department Holiday Party?

holiday party

 

It’s almost that time of the year. And if you have not received an invitation yet, it will probably arrive in your email or mailbox soon. Yep… It’s time for the annual radiology department holiday party.

Our department has hosted a party every year since I started as an attending in my practice. (over 17 years ago!) Faculty expect most of our residents to attend the festivities since it is such a deep-seated tradition at our organization. And most do.

But what if you are on the fence? Maybe you have other obligations or are not the party-goer type. Whatever the case may be, you need to decide whether to attend or not. Well, I am here to help you with that decision! Let’s go through six reasons you should try to make that holiday party if possible.

Esprit De Corps

You are not just a radiologist but also a team member. Showing up displays your pride in the organization and lets everyone else know you care about the department. Now, all the others will understand that you are a team player, too!

Befriending Your Colleagues

What better opportunity to get to know your colleagues? Not just your fellow residents but the technologist who works down the hall and the nurse who cares for your patients. You can finally see these people not just as hospital employees but also as living human beings. You can even dance the Macarena on the dance floor with them, too!

Get To Know Your Attendings

It can be hard to get to know your bosses when they are involved in patient care and running a residency, telling you what to do. You may feel uncomfortable with the party because you now must sit down with them and chat. Now, you can spend time with your “difficult attendings” in an environment unrelated to your primary occupations. Who knows? Maybe it will lead to an excellent recommendation!

To Be Polite

You know… Someone had to shell out the money for the party. And the radiology department invited you to enjoy a party with them. Is it nice to skip out on an event created just for the benefit of all to enjoy? Not really!

Getting Involved

You can’t always study. Sometimes, you have to get out there and get involved. Getting involved can be as simple as showing up early to work up your patients. But it can also mean attending a party. You’ve signed up for this residency. So, show up for the events!

Find Out What Really Happens In The Department

Few better opportunities arise that allow the resident to see what happens in the radiology department. When the attendings “let their hair loose” and have a few drinks, you know who plays with whom. And, you get the real low down about what goes on. You can’t learn everything from a book!

Is It That Important to Attend The Holiday Party?

Yes!!! We struggle all year to work hard to learn and improve patient care. It’s now time to take some time aside to get to know our department. Let us enjoy the fruits of our labor together!

 

 

 

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Paid Surveys For Radiologists Revisited

Completing paid surveys is probably one of the easiest methods of earning some extra cash on the side. And as we know, when you have hundreds of thousands of dollars in debt, every little bit helps. In addition to the extra cash, surveys have enabled me to learn more about some of the newest radiology technology and products that I may not have learned about otherwise.

In the past, I have briefly addressed opportunities for completing paid surveys in my prior post called Alternative Careers And Supplemental Income For The Radiologist. But today, I thought I would go into some more detail about surveys since I regularly participate. So, let’s start by talking about the general rules for deciding when it makes sense to complete a survey, go through the different types of surveys, and then finally delve into some of the opportunities that are available out there based on my own experiences.

My General Rules For Deciding If A Survey Is Worth The Effort

You will find that surveys vary widely in the amount of time and effort for a given amount of cash. Unless you really enjoying completing surveys for free, survey companies should compensate you well for your knowledge and time. Remember, even medical students usually have more education than the folks giving out the surveys. And, education comes at a price. So, I would recommend to not allow the survey companies to take advantage of your goodwill.

In fact, let me give you my rule of thumb. A survey company should compensate you at a rate similar to or greater than what you would earn by moonlighting. What do I mean by that? If you are a resident and you can make 100 dollars per hours by working an extra shift, then you should work at a rate no less than 100 dollars per hour. That means if you work on a survey for 15 minutes, you should get paid no less than 0.25×100 dollars or 25 dollars for your time.

Also, make sure not fall for the sweepstakes entry reward for completing a survey. Usually, there is no guarantee you will win. And, you are essentially providing a free consultation.  You are worth much more than that!

Finally, if you need to travel to complete the survey, make sure you calculate the amount it costs to get to the survey. Deduct that amount from the survey fees to come up with a final total to decide if the survey is worth your time. Or even better, have the survey company reimburse you for the travel expenses.

The One Exception To My Rules

But, of course, I have one exception to the rules. (Just like there always is!) If you have nothing else to do at the time, then I permit you to consider completing a survey for less. Why do I think that is a reasonable exception? Well, getting paid for doing something is always better than doing nothing, even if you are not getting paid what you are worth. Hell, you have lots of bills to pay for your medical school training!

What Are The Different Types Of Surveys?

Surveys opportunities vary widely. These include the standard online questionnaire, participation in a phone interview, a direct interview with a survey manager, and sitting on an expert panel. Out of the different varieties, I find the online questionnaire to be the least thought-provoking and energy draining. Other forms of surveys require more active participation. You need to be awake to answer the questions!

In addition, survey companies attend national conferences and offer opportunities for radiologists. Take advantage of these opportunities when they avail themselves. Often times, these opportunities can be the most lucrative.

Overall Best Survey Companies For Radiologists

Over the years, I have found that at any given time, the best survey companies change. Depending upon your specialty, the best radiology survey company may vary. Presently, the following companies still give me the most opportunity to complete paid radiology related surveys at the highest rates: GLG Group and M3 Research. In fact, I remain an affiliate of both of these companies since I complete these companies’ surveys regularly. Of course, other survey companies every once in a while ask for my opinions. On the whole, GLG Group and M3 Research still give me the most opportunities.

Final Thoughts

Although no magic bullet exists for getting rid of student debt, survey opportunities can give a significant boost to your bottom line. Try to avail yourselves of the opportunities when they arise. Who knows? You may even learn or thing or two!

 

 

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When A Disaster Strikes- A Radiology Resident’s Role

disaster

 

 

It’s ironic. A while back, I started to write about disasters and radiology residency in the evening, only to wake up the following day with Las Vegas headlines screaming about a disaster with mass casualties, gunshot wounds, and severe injuries to over 500 people from a crazed gunman. Unfortunately, these poor victims needed immediate care. And we, as radiologists, were in the trenches. It is only a matter of time before we may encounter a horrible situation such as this.

Perhaps, you are on call at the time. Or maybe, you are the only radiologist in the hospital covering this affected population. Again, we are not discussing a bus collision with a few victims. No. I’m talking about a mass casualty such as this one where hundreds or perhaps, thousands get injured at a time—a dirty bomb, a World Trade Tower-like incident. What should you do first? Who would you contact to help? How would you cope? Where would you go? Let’s sort through some general rules and think through these issues together.

Make Sure You Are Safe To Perform Your Duties

It goes without saying. For you to perform your duties as a radiologist, first and foremost, you must ensure that you are safe. Is there an active shooter in the building? Get out. Are you in a place of radioactive fallout? Move further from the epicenter. You cannot do your job unless you are alive and healthy. So, be aware of your surroundings.

OK. So, you feel reasonably safe at your post. But, you are not done with maintaining your safety. Be aware of the mass casualty situation. Is it chemical exposure or radioactive contamination? Perhaps, an airborne illness. Follow the rules to avoid further exposure to provide the most help to the maximum number of victims.

Does Your Department Have Electricity?

This question might sound a bit silly. But, unique to radiologists, we rely almost entirely on the ability of the facility to generate electricity—no electricity and no x-rays, MRIs, CTs, and so forth. If there is no power, you will unlikely be able to help as much as a radiologist. (except for battery-powered ultrasounds) Instead, you may be only able to help as a treating clinical physician.

Take The Time To Call For Backup

Next… When hundreds or thousands of victims require acute medical care, and you have electricity at your facility, one lone radiologist is unlikely to be able to provide imaging services for everyone. Call the covering attending radiologist in a mass casualty such as this one. Now, you can decide if you need more coverage to interpret or perform all these studies rapidly.

Triage, Triage, Triage

Unlike standard operations, you no longer have the luxury of providing any study to anyone. In this situation, all the hospital’s imaging resources will run out. So, you are in a position to ensure that the appropriate victims receive the correct studies (the art of triage!).

The treating physicians are not experts in imaging. You are. So, you need to monitor appropriateness criteria like a hawk. You want to save the most lives. Only the sickest and most needy patients should receive imaging first. And, of course, they need the correct study.

Read Where Help Is Needed

Perhaps, you are dealing with lots of inhalation injuries. Well, then, concentrate on the chest X-rays. Or maybe, tons of gunshot wounds. Read the CT scans. You should read what is most needed.

Assess What Happened And Create An Action Plan

So, you’ve run through all the initial steps of our disaster protocol recommendations. And you’ve made it through the disaster scenario. What do you do next? It’s simple: Assess the disaster situation and create an action plan.

Creating a radiology action plan becomes essential so that if disaster strikes twice, you know the best ways to handle it. Your hospital should have a radiology emergency protocol even before the disaster. (Not all hospitals do!) So, now is your opportunity to contribute to or create your own hospital’s disaster committee. Make the plan as efficient and as practical to implement as possible.

Disaster Management Summary

No matter how you slice it, as a radiologist and a physician, a disaster scenario can be complicated. So, you need to follow some of these general rules to make running a disaster protocol as efficient and safe as possible for you, the radiologist, and the patient. Be safe, call for backup, triage, and use appropriate resources. Finally, remember that assessing the situation is crucial and developing an action plan (hopefully before the incident!). Next time, if it happens, you will be ready as you can be!

 

 

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Reading Imaging Studies On Our Clinical Colleagues

colleague

The Scenario

A clinical colleague walks up to you, and the following conversation ensues.

Clinician: Can you take a look at my chest film? I have had a cough for several weeks that won’t go away.

Radiologist: Sure. Let me take a look at the image.

The name of the clinician is on the computer, and the scan pops up on the screen

Clinician: Well, what do you think?

The radiologist stares intensely at the screen. Beads of sweat begin to form on his forehead as he sees a spiculated 6 cm left perihilar mass with adjacent interstitial changes and pulmonary nodules in the opposite lung. The clinician stares at the radiologist in front of the desk.

Radiologist: Well… Ummm…

Clinician: Well, what do you see?

By far, reading your fellow clinical colleague’s imaging studies has the potential to be one of the most stressful clinical situations as a radiologist. (as witnessed above) Even worse, the physician-patient may stand directly in front of you while looking at the films for the first time. God forbid we find something potentially lethal or unexpectedly harmful.

Over the years, similar scenarios have played themselves out several times. And, it’s not just me. It happens to most radiologists at some point in their careers, probably you as well. So, what do we do in these situations? Well, you guessed it. That is the theme for today’s post. Let me try to give you a few pieces of sage advice.

Take Time To Read The Study And Call The Clinical Colleague Later

Like I previously advised in prior posts such as Radiology Call- A Rite Of Passage, you are better off taking your time and going through your search pattern rather than being interrupted and making the wrong diagnosis. When a physician-patient stands right in front of you and stares at the screen, you direct your attention toward your emotions, leading to poor discrimination and interpretations. You are not doing justice to good clinical care.

I know. It is challenging to say to the physician-patient, “I can’t look at your images while in the room.” Instead, just say, ” I will look at your images later when I can make my best interpretation.” Most of the time, your clinical colleague will comply (But not always!). It indeed allows you, the interpreting physician, to have time to think about the films and diagnosis appropriately.

Don’t Beat Around The Bush

Your colleagues are physicians and generally know a bit about imaging/radiology. They will see if you are holding back a finding. So, regardless of whether you are on the phone or in person, you just need to tell them what you see. In radiology, however, most findings and impressions (even malignant-looking ones) can have numerous outcomes. In this situation, it is reasonable to say I think it may be x (a malignant diagnosis), but I have seen when it turns out to be y (a benign diagnosis). Of course, you don’t want to give false hope. But we, as radiologists, are rarely 100 percent correct! That gives you a little bit of an out.

Never Farm-Out This Responsibility To Another Radiologist!

Generally, there is a reason why this physician-patient comes to you to read their study. Maybe, they like your skills as a radiologist. Or perhaps, she sees you as a confidant and friend. But for whatever reason, this person came to trust you to read his film. It is never appropriate to shirk your responsibility to talk to the physician-patient by doling the obligation to another physician. It is part of your responsibility as a colleague and physician. Not to say, you cannot get help with the interpretation if complicated. But, you need to be the one that directly speaks to the physician-patient.

Be There As A Friend/Colleague

Finally, as radiologists and physicians, we are all interconnected to our fellow clinicians through the shared medical experience. It is essential to remain present as a friend and colleague to the physician-patient you diagnosed. Give the physician-patient your number to call if they have any additional questions. Commiserate over the diagnosis. Treat this person as you would any friend.

Treat A Colleague As We Would Want To Be Treated!

Our most demanding jobs as radiologists and clinicians are not the day-to-day interpretations of films and coming up with differential diagnoses. But instead, they are the problematic interactions that we may need to have at some point with our colleagues and friends. We need to relay the information to them about their images in an appropriate, correct, and thoughtful way. Even though there is no perfect way to do so, we must treat our colleagues as we want to be treated ourselves.

 

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How To Avoid The Second-Guesser Syndrome

second-guesser

Most of us know other radiologists that fit into the category of second-guesser. Perhaps, you trained or are training under someone like this. Consistently, they debate whether to call a pulmonary nodule or vessel on every other chest x-ray. Or perhaps, when a nurse asks a question about intravenous contrast amounts, they equivocate for what seems like hours. Clinicians don’t know how to proceed. The staff becomes upset. Worst of all, even though these radiologists tend to be very smart, they are targets to lose their job because no one is comfortable with their decisions. You know the type. In today’s post, I will give you some tips to avoid becoming a second-guesser.

Think In Terms Of Highest To Lowest Probabilities

Second-guessers often think about differentials that could be this or that with no differentiation between “this” or “that.” What do I mean? All the different options have the same probability as one another. It is rare for all the differentials to be just as likely as one another in the real world. In less than one out of a hundred cases, there are multiple diagnoses with equal probability of an outcome. So, if it makes sense, stick your neck out a little bit in your conclusion and make your impression the most likely diagnosis. Mention the differential in the comments sections with a description of what is most likely, less likely, and outright unusual. Typically, you will find that you are hemming and hawing much less.

Little Decisions Deserve Little Time; Big Decisions Deserve Big Time

When a nurse walks into the room to ask you how much contrast you should give to a patient with a GFR of 59, you need to decide quickly. Sure, it is somewhat important. We do not want to cause a patient renal failure. But, the difference between giving a patient 100 ccs versus 75 ccs of contrast is unlikely to make much of a difference. This decision is worth no more than 10 seconds of my time in my book.

On the other hand, let’s say you need to decide whether you should biopsy a lesion in the liver. Now, this decision has significant consequences. Biopsies can cause bleeds, infections, and more problems. You really may need to spend some time making this decision. If you have to think through the problem for a while, it makes some sense.

Don’t confuse the little decisions with the big decisions. It goes a long way to preventing you from transforming into a second-guesser.

You Can Miss Em’ Fast Or You Can Miss Em’ Slow

A great radiologist from my residency quoted me the following as he scrolled through a panel of plain films very rapidly, “You can miss em’ fast, or you can miss em’ slow.” I take this statement to heart. Sometimes, when reading cases, there comes the point that looking at a film for a while longer makes no difference in terms of perception. Your first look can be your best look. During the first few milliseconds of looking at a film, your brain unconsciously analyzes the film and can tell if something is off better than staring at an image for hours. Use your gut. Don’t perseverate too long!

Not Every Pixel Is The Same

What do I mean by this? Certain parts of a study are high yield, and others are low yield. For instance, in a patient with breast cancer, metastatic disease likes to go to the bone and liver. So, spend more time looking at these organs. On the other hand, metastatic breast disease does not tend to spread to the spleen. So, use your time accordingly. Spend the appropriate amount of time on each pixel. Pixel selectivity is a tool to prevent you from second-guessing yourself.

If All Else Fails, Make A Decision

Finally, sometimes there are no right or wrong answers. Although not perfect, both directions will allow the clinician to proceed appropriately with a workup instead of perseverating. Sometimes, clinicians need that push to do the right next step for the patient. In this situation, go ahead and make a final decision. You’ll be glad you did!

Avoiding The Second-Guesser Syndrome

Sound advice for avoiding second-guesser syndrome is not emphasized in the radiology curriculum. That’s why I’m here! So, avoid the pitfalls of the second-guesser. Go ahead and create a differential with your most likely diagnosis; utilize the appropriate amount of time for the decision, go with your gut, and spend the right time on each part of the images. You, too, can avoid the second-guesser syndrome and become a decisive radiologist!

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Loss Of A Pet- A Lesson All Residents Can Learn About Quality Of Life

Today’s post is not for everyone. For those of you that have never owned a pet or do not understand why anyone would decide to keep a pet, especially during residency, you can stop reading here. But for those of you that take a keen interest in living with a pet of some sort, I think you will find this post very enlightening.

Most posts I write are not personal. Today’s post is very different. It serves several purposes. First, I aim to show my readers how we dealt with a sick beloved pet during the past few weeks in order to give examples of tough decisions that need to be made. Next, I am going to translate this episode into a life lesson about maintaining a good quality of life, translating it to residency. And finally, more importantly for me, I am going to be a bit selfish and eulogize the recent loss of my best friend and dog, Otis. The past few days have been some of the most difficult days of my life. I already miss him dearly.

The Ultimate Responsibility of Pet Ownership- Our Story

When we decided to commit to getting a dog, we committed ourselves to its entire life. We are ultimately not only responsible for feeding, comforting, bathing, and taking our pets outside but also the decisions we need to make when facing an inevitable loss. The difficulty is only compounded when you are training during the incredibly busy time of residency.

In our case, our incredible dog, Otis, had an episode of spontaneous agonal breathing. Like a madman, I rushed him off to our car and drove him to the animal hospital nearly 70 miles per hour through side streets. I passed him off to the technologist like a football so that the emergency veterinarians could instantly treat him. And, they treated him rapidly and professionally with a pericardiocentesis to drain off fluid during an episode of pericardial tamponade. While performing the ultrasound, the sonographer discovered a right atrial mass. Then, in the morning, the veterinarian radiologist scanned his abdomen, only to diagnose him with splenic nodules as well. They declared that he had untreatable metastatic hemangiosarcoma, a terminal cancer of dogs. It would consume him possibly in days or weeks, and if we were lucky, months.

We faced the ultimate decision after the veterinarians stabilized him. What do we do next? Do we bring him home now? Should he be euthanized? I couldn’t bear to say goodbye at this point because he seemed like he returned to his normal self for the time being. We decided to bring him home, hoping he would have a few more good weeks, maybe months.

The next week was one of the best weeks I ever had with my dog. We walked, let him roll in the grass (his favorite activity!), and allowed him to sniff just about everything. It was great. But, the day of reckoning finally arrived too soon. This time, the whole family came with him to the hospital after we noticed some subtle discomfort and worried that he was to become unstable.

The Big Decision- Quality of Life Issues

We knew at this point we had the big decision to make. Do we treat him with serial pericardiocenteses aware that the fluid accumulation and new episodes of pericardial tamponade would become more and more rapid? Or, was it time to say goodbye? We based our final decision on his quality of life. We had to say goodbye.

It was one of the most gut-wrenching decisions, I ever had to make. He was my best friend on earth.  We slept on the same bed, traveled together, and ate meals with each other. He was always there for me over the past 10.5 years. It was his helplessness and innocence that pulled at my heartstrings. And now, I had to put him down. It was for the best. But, it made the decision no easier.

Life Lesson

What is more important than the quality of life? Whether it is a person or a pet, it does not matter. We need to do for our loved ones what is right for them and not for ourselves in the moment.

Translated into the residency experience, we should always think about the quality of not just our own lives but also the quality of life for our spouses, relatives, friends, family, and beloved pets. It’s not always about reading the most cases, staying late every day, only to miss out on our loved ones as time passes by. Bottom line. We need to sniff and smell the roses, just like Otis always did.

Ode to the Memories of Otis

You were the size of a toy truck when I picked you up in Charlotte, North Carolina over 10 years ago. You lovingly sniffed me and graciously accepted me into your life. I thank you for that.

Driving home from the airport, you slowly pushed open the Sherpa bag with your nose as I drove you to our house to see what was happening. Your curiosity was always without boundaries. I thank you for that.

Rolling in the grass was your heaven. You could always spontaneously enjoy the moment. I thank you for that.

When other puppies would bite the hands of their owner to get a treat, you would make sure to take the treat carefully always making sure that we were OK. You were always like that in your life. I thank you for that.

Sitting crosswise, you were always there to protect the kids. I thank you for that.

Good-natured and non-aggressive, you were beloved by all the people and canines you have ever met. I thank you for that.

For all the wonderful memories we had together over the past ten years, I wish we had more. Your life was too short. And, we will miss you dearly. The great memories of you will last our lifetime and beyond. I thank you for that…

From Your Beloved Family- we give thanks for every moment we shared together. Rest in peace…

 

 

 

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How-To Procedure Manual For The Klutzy Radiologist

procedure manual

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!

 

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

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!

 

 

 

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Should Radiologists Ignore The Phone?

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

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Ten Disastrous Consequences Of Poor Study Habits

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!!!