Tag: covid-19

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Going Through A Covid Surge? It May Help Your Career!

surge

Yes. Covid-19 has been an epic disaster. But, in any emergency, opportunities arise. And a new Covid surge is no exception. Sure, the hospital may curtail or delay some of your training in radiology. However, this pandemic affords you other chances to establish a reputation for yourself in your hospital and community. And, you will learn other clinical skills that are just as critical as radiology. Demonstrating your prowess in these dark times can lead to unforeseen possibilities in the future. These opportunities can prove themselves more valuable for your future than you might think at first glance.

So, what are these potentialities that I am referring to? Your experiences and performance during the Covid era can lead to job openings, better recommendations, networking, improved clinical skills, better awareness of the community, and more if you play your cards right. Let’s talk about how.

Increased Contact With Hospital Administration

In a typical environment, most residents have very little to do with the hospital administration. At the beginning of the first year, they may hear a few words from the executives to introduce them to the hospital. And at the end of the last year, they help to hand out the diplomas. That’s about it. But, in many departments, this paradigm has shifted.

Now that you are providing a service for the hospital under extenuating circumstances, you are more likely to have the ear of the administration. If you ever want to start looking for a job in the hospital and perform well, they will more likely remember you when the time comes to search. Even better, if you ever want to look for a career in hospital administration, there is no better time to prove your worth and team-building skills than now.

Better Recommendations

Tough times call for more teamwork. And, what better way to get to know your attendings than a stressful situation such as this? In actuality, faculty are more likely to get to know their residents when you are in close contact. You are no longer just another resident! And, this will show in the recommendations that you receive.

Increased Intra-Departmental Networking/Learning

Since you will most likely work with different teams of subspecialty physicians throughout the hospital during a covid surge, you will get to know your colleagues better. Believe it or not, cross-currents of learning and insights into other specialties also help with becoming a better radiologist. It could be pulmonary, cardiology, or pathology. All subspecialties overlap with ours!

Just as critical, establishing relationships with other physicians that you would never have seen as a radiology resident, will make you more valuable. Who would other physicians instead refer patients, a radiologist that they know well, or someone else?

More Awareness Of Clinical Medicine

Sometimes in radiology, we can grow farther away from the real reason why we went into medicine in the first place, to help patients. Having more direct interaction with patients, even in an unforeseen emergency such as this one, can lead us back to our clinical roots and remind us why we are radiologists in the first place. It allows us to rehone our clinical skills that will come in handy later on as an attending.

Getting To Know The Community

Some residents go to residencies based on the quality of the program alone, ignoring the community. However, you also serve a community, and sometimes getting into the clinical nitty-gritty can allow you to understand the patient populations for which you work. If you doubt the importance of your role in helping out the community, look at the media presentation of healthcare workers. Typically, they present all of us (even radiologist residents) serving the hospital as heroes. Heck, in our community, the leaders hosted a parade for the folks at the hospital to demonstrate their appreciation. So, if you think that you do not influence the community, you are dead wrong. Getting back to these roots will allow you to appreciate once again where you work!

Time To Prove Your Mettle During A Covid Surge!

I know. You may not have bargained for these circumstances. However, there are always a few golden nuggets that we can take away in almost any bad situation. So, even though you think there is no value to having work other roles in a surge, it may be more helpful to your career growth than you think!

 

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Should Hospitals Force Radiology Residents To Work In The ICU During The Covid Crisis?

ICU

Radiology residents are working in the ICU or the wards to meet the increasing demands of an influx of Covid-19 patients, sometimes having little to do with their training. And, most residents have graciously accepted their new duties, in the name of helping a higher cause. But why must residents comply with these demands? Are hospitals treating these physicians fairly? Is it ethical for h0spitals to require residents to participate and forego training in their desired subspecialty? And, what must the hospital ethically provide in return? Let’s answer some of these burning questions as it reveals some underlying issues about residents and residencies themselves.

The Government Indirectly Hires Residents

Once you sign your residency contract on the dotted line (or solid line!), you are receiving a salary from not just the healthcare system that employs you, but also indirectly from a pool of money provided to the hospitals by Medicare. And, most residents receive these government funds in one way or another. Therefore, you are indirectly working as the Government’s servant. In this setting, residents must comply with the Government and the hospital to receive a salary. So, hospitals do have the right to set aside educational objectives for the moment (even though it may not be what you bargained for!)

Residency Has Service And Educational Obligations

It’s not all about take, take, take! There are two components to any residency, educational and service obligations. Not too long ago, in an attempt to get back Social Security taxes from the Federal Government, residents sued the IRS because they claimed that medical residents were students and not employees. (Check out this article) In the end, the Government returned taxes to residents because the Government never clarified the definition of a resident. However, nowadays, the definition of residency changed. Today, the Government/IRS considers residents to be employees, not just students. And, for that reason, all current residents pay Social Security taxes as well as need to comply with government/hospital demands for service. (That includes time in the ICU!)

What Do Hospitals/Government Need To Provide In Return?

Hospitals have a moral and ethical obligation to provide a safe environment for resident trainees. Any institution that does not offer such a setting violates the spirit of a resident’s contract with the institution. What does that mean? Well, hospitals should treat residents like any other employee. In the case of this epidemic, hospitals should provide residents with the protective equipment they need to stay safe. No resident should risk life and limb without the appropriate accommodations of the institution in return.

And, hospitals should continue to pay their residents at their negotiated salary. Understandably, hospitals are struggling with the lack of revenue from canceled elective procedures. However, the amount that they receive for maintaining residency programs remains fixed by the Government. Therefore, it is only fair that residencies should continue to receive their salaries without furlough or pay cut. They are not the same as general employees whose wages can be subject to market forces.

A New World Order For Radiology Residents: Time In The ICU

No. ICU work is not what most residents signed up for when they began their radiology residencies. However, radiology trainees are still, first and foremost, physicians with service obligations. Part of these requirements is a duty to do no harm and help patients. Moreover, hospitals also have ethical and moral responsibilities toward their residents. Therefore, when both the resident and hospital meet these conditions, radiology residents can and should play a role in meeting the new needs of the healthcare system. Hey, when did you ever sign up for something that was as you exactly expected?

 

 

 

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Danger Of Using Case Studies To Dictate Imaging Policy: The Initial Covid-19 Study

case studies

Rumors abounded at the beginning of March 2020 about Covid-19. And, no one quite knew how Covid-19 would play out. All sorts of physicians were on edge to try to figure out what to do. But then a new case study about the role of CT scan arrived at the scene. And, clinicians began to read or hear about this “seminal paper” in Radiology that came out from China, called Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. This paper claimed a high sensitivity for the detection of the diagnosis coronavirus compared to PCR. Admitting physicians quoted it and demanded to get CT scans on their patients with presumed Covid-19. ER doctors were ordering Chest CT scans left and right.

What happened next? The throughput of patients slowed down to a crawl because the CT scanner needed special cleaning for potential Covid-19 contamination. Subsequently, this thorough cleaning delayed the treatment of patients. And, the CT scanner was out of commission for other patients that needed the CT scan for emergency workups.

Was it the right to use this paper to dictate the workup of patients? In hindsight, no. And, it brings up an all too common issue, the usage of case studies to dictate health care policy. So, what are the other factors that we need to evaluate before we decide to take a paper and apply it to patient care? Well, I will use this incident as a way to show you what you need to think about before using case studies to guide patient imaging. Let’s divide it into the following categories: practicality, throughput, exposure, and change in management.

Practicality- It’s Not All About Sensitivity Or Specificity

I don’t know about you. But, whenever I hear a test is highly sensitive or specific for a disease entity, I get excited. My first thought is usually, maybe we can use this exam to diagnosis patients? However, before arriving at that conclusion, we need to take a step back. Does the test make sense in the context of patients coming into the emergency department? Many clinicians did not think about these issues when they decided to utilize a CT scan to image presumptive Covid-19 patients. Just because you can make a diagnosis does not mean that you should complete a test.

Throughput is Important

A test is only useful when it can rapidly diagnose patients. In the case of CT scans for the diagnosis of Covid-19 patients, regardless of any other factor, our throughput for patient care significantly slowed down. And, this had a dramatic effect upon the patients that came into the Emergency Department for many other reasons. Always, physicians need to take this factor into account before jumping into ordering a test.

Exposure To Health Care Workers And Patients

We need to take care of all the folks that are providing services for the sick and infirm. If we do not perform this duty, we will have no health care workers to treat patients. In this situation, deep cleaning the CT scanner after each patient added undue risk to the technologists and nurses that completed these functions. Not to mention, you are also increasing the possibility of exposure to the next patient in the CT scanner. The upshot was a tremendous cost to the patients and employees.

Does It Change Management?

And, then finally, the most critical question that we need to ask ourselves is how does the test change management? In the case of Covid-19, a negative test did not preclude the possibility of the disease. So, regardless of the test outcome, the clinicians would need to use their clinical intuition to decide if they need to ventilate the patient or other invasive measures. Moreover, the treatment of the patient would remain the same, whether the CT was positive or negative. Why submit a patient to such a test?

Beware The Dangers of Using Small Case Studies To Dictate Policy!

We all need to take a step back when we hear the claims of physicians that we should be imaging a patient based on a paper. Instead, you should be answering the following questions: Is it practical? Will it prevent other patients from receiving appropriate testing? Will it endanger my staff and patients? And, does it change the management of the patient’s case? If the case studies can pass these tests, consider using it as a tool. If not, beware of imaging the patient based on a paper, the test may do more harm than good!