Tag: order

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Don’t Skip Around! A Radiologist’s Mantra

skip around

Round, round, get around, don’t skip around. Reminds me a bit of the Beach Boys tune I Get Around. Regardless of the weak attention-grabbing first sentence, I think this advice is vital for the radiologist.  And it applies to us in many ways. First and foremost, it helps to ensure that you are covering all the findings. But, it is far more than this. Keeping reads in order without skipping around also will enable you to triage appropriately, allows you not to piss off your colleagues, and most critically, ensures that you don’t forget the reason for reading a study. So, let’s delve a little bit more behind each of the reasons behind the nitty-gritty of this philosophy.

Covering All The Findings

What is the best way to make your dictations less accurate? Well, have as many interruptions as possible! And what is it about these interruptions that cause missed findings? Typically, most radiologists will forget what they were doing before.

Since it is impossible to prevent all interruptions (although you can mitigate them), you can avoid loss of sensitivity by sticking to a routine without skipping around. So, the next time the surgeon barges into the room with a question while you are dictating, you will know exactly where to return your focus when the interruption ends. If you repeat a similar routine without skipping around, you will rarely lose your place for long!

Triage

What is it about skipping around through a list of patients that can cause triage issues? Well, it’s not fair to read a study first on a patient with similar urgency to others when he was the most recent one completed, right? How would you like it if someone cut in front of you in line at a supermarket? It’s the same philosophy.

But more critically, you should be reading the tech flagged positive findings first, the “STATS” second, the expedites third, and the routines last. Subverting this order can cause clinical disasters, potentially delaying reads on patients with positive results. Why would you want to read a routine oncology workup before a possible intracranial bleed after trauma? Finding a lung nodule is not equivalent to discovering an epidural hemorrhage. Triage in order and don’t skip around!

Order Among The Rank And File

When all members of a practice are working hard, they don’t want to worry about radiologists that are cherry-picking the most straightforward cases to spruce up their RVU numbers. How can a practice avoid such an issue? Well, have the readers read studies in order of when they were performed. Practices often perceive those members that skip around to be skirting the rules.  So, sticking to the list order can help morale!

Circling Back To The Impression

And then finally, to come up with an appropriate impression in any case you read, you should never jump to it without analyzing all the findings first. Skipping around and getting to the conclusion right away is a formula for disaster. Think of it like watching the end of a movie or novel without watching the beginning. How can you figure out the real answers to the clinician questions without going through an entire case? I know that just the mere description of the findings helps me to come up with an appropriate conclusion. Without that process, my impressions are more likely to be off-the-mark. Don’t’ skip this routine!

Following A Radiologist’s Mantra: Don’t Skip Around!

Order matters. Whether you are skipping around instead of using routine search patterns, reading cases in an illogical order, or creating an impression before looking at and analyzing all the findings, you can negatively affect both your partners and patients. We want to do the best for our patients and work partners. So, the next time you decide to accomplish a professional task out of order, think twice. It may not be the best for patient care!

 

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Is Your Residency Like The Lord of The Flies?

residency leadership

If you have not read The Lord Of The Flies, you are missing out. It is a “must-read” for all professionals and especially for residents and residency leadership. For those of you who have never read the book, the story is about human beings’ “true nature.” A plane crashes on an uninhabited island, and the survivors are children without any adult supervision. The children create a society that slowly devolves into utter chaos. The book uses this as a metaphor for civilization and culture.

Well, how does this relate to radiology residency? Some residency programs over time become “leaderless.” This situation can occur due to a change in program directors, weak, ineffectual leadership, or program leadership in-absentia. When this happens, the residents may take over the “island.” This debacle can sometimes lead to utter chaos since most residents do not have the training to understand what is essential in radiology residency and beyond. Individual programs need residency leadership.

So, what are the signs that your residency program has turned into the Lord of the Flies?

Residents Arrive Late And Leave Early

You know the residents rule the roost when the program has no accountability for the attendance of your fellow resident colleagues. Your fellow resident arrives at noon because they “need to study” and leave at 2 pm for happy hour at the local bar without some form of consequence. Members of a residency “island” cannot survive unless all the participants band together and work to make residency the best it can be!

Residents Not Showing Up On Rotations

Residents miss out on the most crucial residency experiences when they miss their rotations. These rotations are the time to learn how to be a great radiologist and understand the subtleties and context of their future profession. Instead, the radiology residents gather in the library downstairs to read books rather than active cases. It’s just like not showing up to the hunt to get food for the members of your island. How can you survive?

Infighting Amongst Colleagues

When your fellow residents have decided to divide into two factions, constantly trying to throw each other under the bus, you can’t even look at your fellow residents in the eyes without arguing or getting upset. Even giving each member of your residency a conch before speaking does not help!!!

Shirking Responsibilities

You notice that the radiology residents ignore their responsibilities. The attendings are now performing “resident procedures” like sentinel nodes and paracenteses. All members of a “residency island” need to perform their duties. In the book, the responsibilities of the society were to create shelter, forage, and hunt. In a residency program, it is performing procedures, consenting patients, and reading studies. Residents need to perform these duties to receive the training they need to meet the needs of the survivors. Perhaps, the faculty do all the work because they cannot rely on the radiology residents!

No More Evaluations

If the program director and attending staff have not evaluated you over the past year, the program leaders are likely not following up on your training. The leadership has abandoned its post! Each member of the “residency tribe” is now forced to assume that they appropriately perform their duties. Residents learn bad habits that can stick for the rest of their careers without the guidance they require. How can the individual know what to improve when the residency provides no feedback?

Educational Meetings Are Gone!

When the educational committee disappears, the individual resident has no representation in how they learn radiology during the four years of residency education. Just like the book, once the tribe members no longer have a say in the functioning of the island, the “leaders” slowly take over and create an oppressive society. Those who did not comply were tortured and killed! Education needs to be a partnership between the residents and attendings.

Residency Leadership And The Lord of the Flies

All residencies need leadership with the best intentions of the individual resident physicians in mind. Sometimes it means rules and regulations that the program needs to enforce that allow the individuals to maximize learning. Other times, it requires the participation of its constituents so that the program gives the best educational experience possible over the four years. If these institutions are not in place, you are in for a rough ride. Your residency island may not survive!!!