Tag: radiology

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A Review Of Med School Insiders Insights Into Radiology

med school insiders

If you are like me, I am an avid youtube fan. Since it is in my wheelhouse, one of the topics I occasionally search for is radiology (in addition to astronomy, Ukraine, and guitar lessons!). And as I was surfing the YouTube world on these topics. I hit upon a series of videos with the hypnotic voice of Dr. Jubbal from Med School Insiders, a business that caters to students who want to enter the field of medicine. Many of these videos claimed to review Radiology as a field, including salaries, types of residents, the culture, and more. But does that mesmerizing voice have it all right? Or, is much of what Dr. Jubbal says about radiology a farce? Here is a review of the world of Dr. Jabal, and Med School Insiders impression of the field of radiology and whether he gets it all right.

Salaries- In The Middle Of The Pack?

The videos emphasizing radiology talk about salaries and consistently talk about radiology as somewhere in the middle of the pack. That phrase can be very misleading. As someone within the field, knowing where we stand in the salary ranking, I know that salary is highly dependent on where you work, whether you are in private practice or academics, and a slew of other factors. Based on my own experiences with these factors, radiology has been more consistently toward the top of the salary distribution on average than most other specialties. But, of course, it is possible to find a lower-paying radiology job.

Med School Insiders Talk About Artificial Intelligence

This factor is where Dr. Jubbal gets it wrong. He uses artificial intelligence as a risk for new students entering radiology. Artificial intelligence has consistently been underwhelming for most radiologists out there as a way to replace radiologists. The best CAD detectors for mammo and lung nodules have consistently underperformed expectations. The biggest problem with artificial intelligence is that there are always new data sets that the researchers have not inputted into their algorithms. And, any independent reads by a computer will not be able to take these myriad factors into account for a very long time. I don’t see any chance of it taking over a radiologist’s job for more than fifty years from now.

Even if artificial intelligence becomes more successful, radiologist numbers  are still way too low relative to the amount of work out there. Artificial intelligence may even boost efficiency to get more done in less time, enabling radiologists to do more with less and increase earnings. (That would be a good thing) Artificial intelligence, therefore, is not much of a risk at all to the profession. Sorry, Jabal!

ROAD/Flexibility

Dr. Jabal constantly adds radiology as part of the lifestyle specialties. Sure, we have one of the most flexible specialties regarding work location, shiftwork, and type of work. However, many of us have become insanely busy because we are replacing a lack of physician staffing elsewhere, i.e., emergency medicine, family medicine, etc. For this reason, patients will often get pan-scans without being seen by clinicians first. So, many of us have become very busy trying to keep up with the demand. So, I’m not sure we belong on the ROAD list anymore!

More Introverted Specialty

On this subject, I would have to agree on a bit. Although I know lots of radiologists who are very outgoing and personable, many radiologists would prefer to work alone as well. In other specialties, this introversion does not fly as well when you have to see tens of patients daily—seeing patients could become exhausting for an introvert. Radiology is a way to avoid the constant bombardment of patient contact. (Of course, it does not have to be that way!)

Competitiveness

Here is another area where I would have to agree with Dr. Jabal. Although the trends have become more competitive lately since COVID, we are certainly not as competitive as dermatology or orthopedics. We place somewhere in the middle of the pack, maybe a bit more toward the upper end of the mid-tier lately. Dr. Jabal seems to emphasize a similar level of competitiveness, somewhere toward the middle of the middle, That ranks close enough to the mark.

Doctor Jubbal, Med School Insiders, And Radiology

So, yes, Dr. Jubbal does toot his own horn as he had formerly trained as a plastic surgeon and subtly suggests that plastic surgery is the epitome of being a physician. If you can get past that, he does get some impressions of radiology right, especially the appeal to introverts and the general competitiveness of radiology. On the other hand, he misses the mark a bit for others, such as salaries, artificial intelligence, and the ROAD concept for radiology. But, overall, he does not do so badly. His youtube segments are enjoyable to listen to and can help residency applicants in general. My advice, though, is never to use one source for anything. And try to find mentors in the residency space within your specialty of interest. The best advice will come from physicians within the area of training where you want to apply!

 

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Find A Radiology Residency Or Job That Will Feel Like Well-Worn Sneakers!

sneakers

I don’t know about you folks, but when I buy new sneakers, I expect it will take a while before I can break them in. The material needs to stretch out to surround and cushion my foot gradually. Rarely do the sneakers fit perfectly on day one. The process can take months or even years until I get them the way I want. So, I buy them with the expectation of future comfort, not how they feel today.

If I try to buy the perfect sneakers, it never seems to work. I find myself returning lots of footwear (online nowadays!) And, I waste my time and incur multiple restocking fees or trips to the store for returns. So, what do I look for when I buy those sneakers? I look for reasonably comfortable pairs that fit snugly without too much discomfort. Also, I find pairs that will less likely cause me to trip over myself. So, what does this all have to do with radiology? It’s coming out of the left-field, right? Well, not really. Let me explain.

Like buying sneakers, residency programs, or first jobs rarely fit perfectly on that first day. It may be good enough and may have the potential to work well. But, you may notice the imperfections at first. These imperfections may trouble you because you may question if you made the right choice or not. But it would help if you had patience. Why? Because the outcomes can be costly, just like the returned footwear. And here are some of the reasons why.

What Doesn’t Work Perfectly Now Will Get Better In The Future

All the imperfections tend to loom larger when starting a new job or a new residency. You notice the worn call room or the resident that constantly complains. What else do you have to hang your hat on? But, I can assure those same issues that you see right now will most likely go away. Yes, you will face other problems and challenges as well. But, I have never seen anyone join a practice or begin a program that is perfect on the first day, week, or month. It just takes a bit of time for the sneaker to mold to your foot!

You Gain Familiarity With Your Colleagues- First Impressions Are Rarely Correct

How often have you noticed that your roommate or teacher was not as they first seemed in your academic career? In my case, I know that my first impression was often wrong. The teacher that seems bizarre often turns out to be the best. And, that roommate that you thought was off a bit may turn out to change your life. It’s all a matter of perspective. And, in the beginning, our views can be skewed. This sensation can feel just like the sneakers that may be a little bit tight at the top at the beginning!

The Costs To Changing Sneakers (Jobs) Are Immense

It is not so simple if you are leaving your residency program midstream or deciding to change to another faculty position elsewhere. Especially as a family, the costs of uprooting your accommodations, kid’s schools, or workplace are immense. Just like when you constantly have to pay those restocking fees, the price of changing jobs can add up over time and can become exceedingly difficult to recoup. It’s worthwhile to give your present job a second look to make sure that it is not what you wanted in the first place. 

Give The Well-Worn Sneakers (Residency/Job) A Chance To Support And Comfort You!

All outstanding accomplishments take time. So, give your residency or job a chance. Yes, there are times where a sneaker can break, or a rock gets stuck in the sole. In these unusual cases, the damages are irreparable, just like some rare residencies or career paths. But, those times are rare. In the end, you may find that you will live a much more comfortable and happier life if you stick it out a bit. Your feet will thank you!

 

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Rural Versus Urban Radiology- Who Wins?

urban radiology

Go to any radiology forum, and you will see an ongoing battle. Everyone wants to prove their point that where they work is the best. Some vouch for working in an urban radiology setting, and others espouse the benefits of working out in the middle of “nothing and nowhere.” Either way, I’m sure there are merits to both. But, let’s pick this topic apart and check out the overall best place to work for the average radiologist resident that is thinking about looking for their first attending job? To do so, we will enumerate and describe the main advantages and disadvantages of each of these choices. In the end, let’s look at the evidence and conclude as to which one is the most desirable outcome!

Rural Radiology

Advantages

More Benefits/Money

Indeed, this perk is the one everyone hears about the most. The farther away from civilization, the more money that most physicians make. And, why is that? Usually, hospitals need to supplement your salary to get you to work there! Nevertheless, it is a fact, and you can use it to your advantage in the outback!

Slower Pace

Everything work-related crawls at a slower pace in rural radiology. You are simply not going to see those crazy enthesioblastomas as often as you might like. On the other hand, because you are not a tertiary referral center, you can scroll the cases at twice the speed since they are much less fraught with complications.

Less Competition

Typically, you don’t need to vie for every patient and every dollar. The subsequent radiologist may be as far as 500 miles from you. So, you just don’t need to worry. You’ve just gained a few anti-stress points and lost a few pounds right there!

Nicer More Open Facilities

In the rural world, land and buildings are generally cheaper. So, you may notice larger and more modern reading rooms, better IR suites, and more well-designed hospitals in general. Lower costs for facilities usually mean more space for you.

Fresh Air

You probably know that smell when you walk outside into the natural world. Simply put, there is much less soot and grime in the air. So, all the flowers and pollen are hitting your sensory receptors as soon as you walk out the door. But, it is true. Your nose will know the difference when you work in a rural environment. And, you will gain a few extra years of life too!

Appreciative Patients

When medical resources are more scarce, patients tend to be more appreciative. You have a better shot at receiving a box of chocolates every year for your services. What you do is hypercritical in a place where fewer physicians work.

Mixed Results/Depends

You Do More Of Everything

Plus or minus. You may get to do more. Now, this may float your boat. Or it may be a cause for your concern. Either way, you will more likely be doing the arthrograms even though you are not an MSK-trained radiologist. Or you will read the mammo, even though you are not breast imaging trained. It’s part of the rural expectations!

Disadvantages

Less Collaboration

Fewer physicians mean less collaboration. That’s just how the math works. Also, it may be a little bit harder to get other expert opinions from your colleagues and your fellow specialists because they just don’t exist. Something to consider before you start a rural radiology career.

Loneliness,

For some folks, family is everything. And, when you live rurally, you have to consider that you may not have your usual family support structure. If you expect the in-laws to come by to help out with the baby, it is unlikely that will happen too often. Just something to think about when you decide to work rurally.

Different/Lack of Cultural Activities

You will not find as much theater and opera out in El Ranchero. But, you may have an excellent Strawberry festival! You just have to have expectations that you will have to travel to get some of the cultural activities you might expect in a large city.

 

Urban Radiology

Advantages of Urban Radiology

Culture

Some rads love the option to go out and watch the newest incarnation of West Side Story with the most famous actors and actresses. Others not as much. In any case, you will have more cultural options for all these activities.

Restaurants

If you like to eat out, the city is just a better environment. You have much more to choose from. And, you can have your Ethiopian fix (I like that cuisine!) and your Afghan meal for the next. It is just more readily available.

More Physicians/Collaboration

More people means more collaboration. You will have more subspecialists at your fingertips to contact and bounce ideas. It often helps when the cases are more complicated. Second opinions sometimes can be a lifesaver.

More Prestige

Larger cities and larger hospitals offer more powerful titles and sometimes more national/international respect. Working at Mass General does mean something to many other physicians and patients. Your name may carry more weight in the big city if you are into prestige.

Better High End/Tertiary Care

If you need treatment for rare diseases, most patients need to go to the big city. These places tend to be hotbeds of research and new therapies and diagnostic tools. The city is the place to be for this work.

Disadvantages Of Urban Radiology

Decreased Pay And Benefits

With all of these perks come the decreased pay because of the desirability of the location. This factor is more pronounced if you decide on a partnership track somewhere. These imaging businesses can afford to pay their radiologists less because they will come anyway!

Increased Competition In Urban Radiology

More physicians mean more competition for every dollar earned. You can’t just build a new imaging center and expect patients to come. Why can’t they get imaged at the business down the street instead?

Higher Living Expenses

Along with lower pay comes higher living expenses. Costs in cities like New York and San Francisco are out of control. And, even as a physician, the economy may force you to rent. Those Benjamins just don’t go anywhere near as far with those high housing and food costs.

Less “Outdoor” Activities

Cities are more conducive to the museums and theaters but less so to hiking up a beautiful green mountain somewhere. For you, that fact may be a game-changer.

So, Who Wins The War- Rural Or Urban Radiology?

Sorry. But, not every location will float everyone’s boats. However, I can say the following. Consider the rural job if you have significant debt because the cost of living can outweigh almost any other advantages of living in the city. The expenses alone will cause you to delay any such hope of financial freedom. Otherwise, find a place that will suit your needs for a long-term relationship. And that can be either rural or urban depending on your family and personality. Just remember. Weigh the pros and cons!

 

 

 

 

 

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You Will Have A Bad Radiology Day!

radiology bad day

Almost all of us start as wide-eyed, enthusiastic residents, ready to absorb nearly anything. I know I certainly did when I first started. But, eventually, at some point, all the planets will align the wrong way. Maybe you missed a finding and then dealt with an angry surgeon. Then, that same day, you had a heated argument with an OB/GYN resident who ordered an inappropriate study. Or, the chairman chews you out for not helping out one of the referring clinicians. Regardless of the number or sequence of events, you must expect some bumps in the road. As much as I like radiology, unforeseen problems will occur. So, how do you get your head back in the game after a bad radiology day like this? Here are some tips to help you proceed when you feel the radiology world is not in your favor.

Play The Long Game

I am sick of the cliche: “Residency is a marathon, not a sprint.” But, it is true. You have four years during your residency to learn and fulfill your goal of becoming a competent radiologist. A bad day here and there is not the end of the world (although it might feel like it!) For this reason, keeping your long-term goals in mind is essential to keep you on track. You can think of a bad day as a life lesson that will make you a stronger radiologist at the end of your residency.

Learn From Your Bad Radiology Day Mistakes

You may feel that miserable lump in your throat when you’ve made your mistakes. It’s never fun to miss appendicitis or have a team of surgeons berate you. But, good residents and learners will take this opportunity to self-correct and avoid making the same mistake twice. This principle is practice-based learning in a nutshell. Those who succeed at this will eventually become excellent radiologists, even if it doesn’t feel like it right now.

Maintain A Positive Attitude

Remaining positive can be a tough nut to crack in the face of stark adversity. But enthusiasm and positive attitudes do go a long way to getting you through that bad day. If you let the negative Nancy nay-sayers get to you because you are having a bad day, how can you treat the next patient well? We have to remember our goal as physicians is to help patients. A negative outlook will not allow you to fulfill your true potential.

Take A Mental Break

Sometimes, you need to give your mind and body a break. Listen to some music. Read that book that you always wanted to peruse. Every once in a while, getting your mind out of medicine is healthy. The perfect time to do so is after a bad day. Allow your mind and body to recalibrate. Human beings should not be on task 24 hours out of every day. It is healthy to take a break (contrary to the popular belief of some program directors!)

Learning From Your Bad Radiology Day

Not every day will inevitably be in your favor. The world does not work like that. But, if you play your cards right, you will come out of this day more enriched than when you started. It’s a matter of perseverance. So, remember why you are here, learn from your mistakes, maintain positivity, and give yourself a well-needed rest until you are ready to start anew. These techniques are some of the tried and true methods that will get you back into shape to practice radiology, prepared to work another day!

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What To Do If You Have A Blemish On Your Radiology Application!

blemish

Some of you are applying for radiology this year with a blemish. Maybe, it’s a course or two in medical school that you initially failed but later retook it and did fine. Or maybe, you had a tough time in one of your clinical rotations because of an errant resident or attending. Regardless, now is the time you need to deal with these issues. Why? Because radiology has become more competitive, many program directors toss aside many applications with a blemish since there are many without them. This problem can also be the case, even though you would be an excellent candidate for radiology. So, what can you do?

Own The Blemish

First of all, don’t disregard the facts. Own your blemish. Yes, you may get fewer interviews than others. But, if you play your cards right, you can increase your chances of acceptance at sites where you interview.

By owning the blemish, you need to have insight into what caused it in the first place and use it to make you stronger. Yes, it will affect you. But, you need to address the issue. The program director will ask you about it. So, explain in your personal statement. Show what you learned from your blemish and why it can be a strength rather than a weakness. No radiologist is perfect,  Don’t go hiding it or sweeping it under the rug. Most programs will know or find out!

Complete Radiology Research

Radiology research is the grand equalizer. It shows that you are interested in radiology even while busy with an internship or senior-level courses. And, it allows you to succeed even though other parts of your application are subpar. It is not a cure-all, but it can compensate for some faults elsewhere. Heck, a paper of yours that gets into the New England Journal of Medicine will undoubtedly elevate your application to a much higher level!

Ace Your Internship/ Senior Level Courses

This statement goes without saying. However, many applicants concentrate so much on the blemish that they don’t get the grades in their most recent courses or internship that will give them that needed boost. Don’t forget that your current courses can count just as much as the blemish. If you don’t perform well on your current rotations, all may be lost!

Do Well On Your Remaining USMLE Exams

All is not lost if you did not ace Step I or even II. Yes, it will make it a bit harder since many programs screen those exams. But, whether it is step II or III USMLE that you need to take, they can still matter a lot if you do very well, especially while you are busy with other endeavors. It shows you can handle stress well and have the potential to pass the radiology core exam.

 And remember, for those of you who have not yet graduated, USMLE step I is no longer going to be scored in the future. So, the Step I exam will become less of an issue (unless you fail, of course!)

Get To A Know A Radiology Residency Program

Finally, try to get to know the faculty in a radiology residency near you. Maybe, you are in medical school and have access to the folks in a residency program. Or you are amid an internship. In any case, attempt to get to know the staff in the local residency program. Ask to meet with the faculty or participate in projects. These connections can help get them to know you as a person and not just as an application with a blemish!

Applications With A Blemish: All Is Not Lost!

I cannot give you a money-back guarantee that you will find a spot in a residency with an application blemish, especially as radiology has become a bit more competitive. However, in most cases, all is not lost. If you own the blemish, complete research projects, do well at your current level, ace the following USMLE exams, and get familiar with a radiology residency faculty, you can surely up your chances of getting accepted!

 

 

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Are All Radiologists Destined To Have Chronic Back Pain?

back pain

After walking my dog a while back and pulling a back muscle (thankfully, I recovered), I started to think about the risk of lower back pain and radiology. Am I more prone than others to having back issues? What are the chances that I can permanently have back pain from my day-to-day work? And, are the risks related to what kind of radiology you practice?

According to the literature, if you are a radiologist who sits and reads lots of films from a PACS workstation or an interventionist who always wears lead shielding and does procedures, your back may not thank you. Based on reality in the field, the human body was not meant to sit for many hours or stand in one place with heavy weights. So, let’s drift into the nitty-gritty data on radiologists and back pain. Then, we can discuss some standard solutions to remediate our woes.

The Hard Data About Radiologists And Back Pain

Here is some of the information to support these radiology-specific related back issues. In one study in the JVIR, the mean prevalence of the general population was around 31 percent for everyone. Then, when you look at the radiology community more specifically, you even get more stark statistics. Within the interventional radiologist population alone, 20.1 to 24 percent have back and neck pain limiting work. Additionally, the same study reported a prevalence of lower back pain in the general radiology population of 52 percent and back and neck pain in interventional radiologists at 60.7 percent. If you believe this study, the prevalence of back pain in radiology is nearly double the general population. This number is not small. It is the majority of us!

Another JVIR article states that the prevalence of back pain gets worse with age, especially among those who complete interventional procedures. (We all have something to look forward to!) That makes sense because of the extra weight that interventionists need to bear. The only saving grace is that radiologists have less back pain than nurses and techs. But that does not change the fact that we have a very high prevalence of back pain as radiologists.

The Only Solution: Prevention!

The last thing that radiologists want to do is get into a situation where you need back surgery. We all know that is the last resort. Heck, many of us read many spine X-rays and MRI horror shows. Some of the solutions espoused in the JVIR papers are reasonably simple. Taking a break is the best plan of action. If you notice that your back is beginning to hurt, you must take a break. Repetitive motions can exacerbate back pain. Exercises involving strengthening the back muscles may prevent significant injuries.

Others are more immediate and easy to do, including lifting slowly, sleeping on your side, and avoiding rapid bending movements. Stretching can also potentially prevent some forms of back injury (I’m a big proponent of this one!)

Finally, ergonomics helps with the situation. That means appropriately positioning equipment and monitors, back supporting seats, clearing the floors of obstructions, and custom-fitted garments for the interventionists among us.

Let’s Face It: Chronic Back Pain Is The Radiologist Bugaboo!

For surgeons, needle stick injuries are a big concern. For psychiatrists, their most significant issue is mental wear and tear. But we, as radiologists, face chronic back pain as our most prevalent job hazard. Furthermore, based on my recent back issue and this short survey of the literature, we need to take the prevention issues seriously. As the old Benjamin Franklin quote goes, an ounce of prevention is worth a pound of cure. Don’t let your imaging centers and hospitals convince you otherwise!

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How To Overcome Imposter Syndrome As A Radiologist!

imposter syndrome

It’s the beginning of the new academic year. Many of you have just started your journey in the radiology world. Others are beginning their first foray into fellowship or as an attending. In each of these situations, you will likely start to doubt yourself. In the case of a first-year resident, other physicians will ask you questions that you believe they know more about than you do. As a fellow, you are probably unfamiliar with all the subtleties in your “expertise.” And, as a new attending, it will be hard to believe that your name will go at the bottom of the report, possibly alone. How can you handle all this responsibility? Are you even worthy? In each of these situations, you are undergoing imposter syndrome. You feel like you don’t have the knowledge and confidence to play your role in the healthcare system. So, what do you do?

Solutions To Imposter Syndrome

Act The Role

Now, I don’t want you to get in trouble. Of course, don’t say things that can negatively affect patient care, especially if you don’t know a topic that can affect a patient’s morbidity or mortality. However, if a resident or attending stops by to look at a film, don’t hesitate to say yes. Go through the case. Look at the priors and the report. When you look at cases with other staff, you develop more confidence in your consulting role.

Additionally, make yourself available for all procedures. Each time you perform the subsequent barium study, PICC line, or paracentesis, your hands and brain become slightly more familiar with the technique. This process allows you to feel more comfortable in your skin. Eventually, you will feel like you know what you are doing!

Becoming good at a role involves becoming a good actor at first. Eventually, the acting job will turn into your career, assuming you put in the work. And you will feel like you know what you are doing!

Read A Lot

As you probably know, radiology involves much more reading than most other specialties. This burden is due to our overlap with many specialties and the core examination. If you are not reading, you sure will feel like an imposter. At a conference, everything sounds like mumbo jumbo chicken gumbo. With the clinicians, you will be at a loss. But that all changes once you start reading intently. I promise. Whether reading films or other complicated radiology tasks, you can answer questions and feel comfortable in your skin.

Get Involved Actively In Your Specialty

Those who know many others in their career will rarely feel like an imposter. If you know all the “muckity mucks” locally, regionally, or nationally; you will feel much more grounded and connected to the world of radiology. So consider heading out there and meeting and networking at the RSNA, AUR, ARRS, and more. (especially when the pandemic eventually subsides!) Or, get involved in your hospital administration by participating in conferences, GME, or other resident administrative roles. Each time you do so, you will feel more invested in radiology and less likely to catch imposter syndrome.

Imposter Syndrome And Radiology: You Can Overcome It!

Only a few simple steps can move you down the road from imposter to maven. Acting the role, reading, and actively getting involved in your specialty are simple ways to move in that direction. Most of us feel like an imposter from the get-go. We have never done anything quite like radiology before starting our radiology track. But you can leave that position quickly. It’s a bit of work to end imposter syndrome. So, get cracking!

 

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Disrespect From A Surgical Attending- How To Deal?

disrespect

Question About Disrespect From A Surgical Attending

The Situation

Hello, I am a radiology resident berated by a surgeon with disrespect in the reading room in front of my colleagues and attendings. An outpatient had imaging findings of small bowel obstruction. I sent a secure electronic message via EMR to the aforementioned surgical attending who ordered the CT scan, an unexpected result that could potentially affect management. I did it out of courtesy even though the hospital policy does not include this as a critical diagnosis that radiologists need to convey immediately. My radiology attending signed the report a couple of hours after I had sent the message. 

However, the surgery attending did not see the message/report until later that afternoon and started to ask me via chat if I had contacted the patient or another surgeon. As per my hospital policy, I did not do that because this is not a clinical diagnosis requiring immediate notification to the clinical team, such as a stroke or pulmonary embolism. The surgery attending took the time to come to the reading room soon after. First, he asked me if I was a resident or an attending; when I answered that I was a resident, the surgery attending started to yell at me for not reporting a critical finding directly. He made it sound like the patient was going to the OR urgently (at the conversation time).

Surgical Attending Disrespect, Exaggeration, And Bluster

Furthermore, he was threatening me that the patient could have died due to the delay in communication. Later, I found out that the surgery attending had already spoken with the patient on the phone. The patient felt perfectly fine/refused to go to the ER and would wait until Monday to go to the clinic (documented in the EMR). Even though we caused no harm to the patient, the surgery attending was very contentious. He made a public scene and stated that I did not do enough to communicate this finding in the middle of the reading room. 

Also, if I had not messaged, the surgery attending may not have found out about the SBO until after the weekend, as the patient felt perfectly normal. The surgery attending cared more about displaying her power over a resident. Her display of power was not for resident education. Is a new SBO on an outpatient a critical enough finding to call the patient directly or attempt to reach the inpatient surgical consult within minutes? What do you think is the best course of action to combat what I perceive as bullying and disrespect? Thank you for listening to my long story.

Answer

There are two main issues in your question. First, let’s first start with the facts about small bowel obstruction. Second, I will discuss the reasons for this public display of power and disrespect and the right course of action.

A Little Bit About Small Bowel Obstructions

Small bowel obstructions without other emergent ancillary findings such as portal venous gas, pneumatosis, free air, bowel wall thickening, SMA thrombus, free fluid, or focal fluid collections are typically managed clinically and are not “emergent.” As your hospital policy dictates, this reason is why radiologists do not usually have to make a phone call to the surgeon at your institution. And, you did more than required by sending the text message. 

Additionally, if you are talking about a plain film diagnosis, these findings are even less specific. I can’t tell you how often I have seen a plain film with dilated bowel loops and air-fluid levels. Then, we get a CT scan, only to see not much happening. A CT scan is a lot more specific for the diagnosis but is by no means perfect. 

Nevertheless, in a pure small bowel obstruction without complication, our role is less diagnostic than management-related. Usually, the surgeon wants to know if it is better, worse, or unchanged. This decision tree, along with the surgeon’s clinical assessment, should factor into the equation of whether they need to pursue the case/management further. The surgeon’s responsibility is to look at the plain film or CT scan with or without the radiologist and decide if further steps are necessary. This role is regardless of however the radiologist reads the study.

More About The Surgeon And What To Do

Based on your story, I suspect that the surgeon is at fault for negligence with the patient. And, I believe that the surgeon is transferring her inadequacies onto you. In my history of dealing with surgeons, the least confident ones unnecessarily tend to take their anger out on others. Unfortunately, you were a target because you are “lower” in the hospital hierarchy. This surgeon is trying to feel better about her faults by displaying her power over you.

If this bullying recurs or you feel that it was egregious, I would refer the case to your faculty in a situation like this. It is wholly unprofessional to berate and disrespect anyone in the middle of a public forum such as a reading room. I don’t care if it is a janitor, technologist, resident, or attending.

Also, it would help if you precisely documented what happened with any other witnesses. That way, it takes the situation to a faculty level with some objective facts. The attending staff can then can decide to talk to the surgeon based on the case. Unfortunately, as a resident, you are not in a position to reprimand or talk back to the surgeon.

On the other hand, your faculty can undoubtedly do so. This way, it should not happen again. And, maybe the institution can change this surgeon’s inappropriate behavior.

I would be very interested to know what you have decided to do,

Barry Julius, MD

 

 

 

 

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Why Artificial Intelligence (AI) Will Not Take Over Radiology!

AI

Artificial intelligence (AI) is still front and center for the layperson when discussing radiology. Family and friends always ask me why AI will not take over my day job. I had one of those “aha” moments in one of those discussions recently. We discussed how many factors will prevent AI from taking over our jobs anytime soon. These included legal, ethical/moral, and financial reasons. As I was droning on, I realized I could argue why AI could overcome these issues. However, one reason not related to these is why we won’t see a blank screen or a computer person from India, China, or any other country for that matter replacing our presence for a very long time. And that is that medicine is local, not universal. 

Medicine Is Local, Not Universal- AI Cannot Account For It!

“Standards”

Why would differing local “standards” be the most critical reason for keeping radiologists busy? Well, every country and every physician has their opinions about the best way to treat patients. Medicine is not universal. It is local. Yes, a few standards are omnipresent, like the Hippocratic Oath not to harm. But, other standards like lung nodule management vary widely among physicians, counties, states, and countries. The Fleishner criteria for managing pulmonary nodules are not standard. Some folks use that criterion; Others use LI-RADS.; And even others use ELCAP. 

I also know some clinicians that modify all these criteria to fit their patient populations. Therefore, it is only possible to standardize standards in an AI computer algorithm when your physician wants to use a different bar from the rest. One great way to lose the radiology business is to make recommendations that run counter to your referrers!

Management Differences Between Places

Different countries have different standards of care. For example, it would not be appropriate to recommend imaging a patient with an MRI of the shoulder in Canada due to lack of availability. Over there, physicians may be more apt to order a musculoskeletal ultrasound. Likewise, a radiologist in Canada may be more likely to recommend a musculoskeletal ultrasound for a possible rotator cuff tear. Yet, an MRI is part of a routine workup in the United States. Why? Because they have a much more significant backlog of patients waiting to get their studies done with fewer MRIs than we do in the United States.

In China, clinicians may regularly recommend “cupping” for different ailments. How can AI programs account for each cultural difference among countries, states, or counties based on availability, preferences, and cultural norms? These obstacles would be exceedingly difficult to overcome.

Differences Between Surgical And Medical Preferences

We work for other physicians. Our role is to make it easier for them to treat patients. And each clinician has specific needs for caring for their population. Oncologists look at assessment criteria differently from surgeons. Neurosurgeons have different interests than internal medicine doctors when they order a study. An AI program needs to consider all these factors when it summarizes findings and makes recommendations. AI is not ready to make different individualized reports for each subspecialist clinician. It would take massive programming power for which it’s not ready!

Differences Among Individual Patients

And finally, even among patients, culturally speaking, some patients want more aggressive workups, and others are more conservative. For instance, I may have a patient who can’t live with a small complex cyst in their breast and wants it drained. Meanwhile, another patient might be more willing to follow it. Some of these differences may be cultural or related to individual differences. How would an AI program account for that? AI is not ready to interpret every patient’s cultural and emotional status to make these decisions. Again, no supercomputer could make these individual recommendations for patients.

A Radiologists Job Is Still Way Too Complex For AI!

Whether it is differing standards, cultural differences, physician preferences, or individual patient preferences, radiology, in particular, is not a one-size-fits-all discipline. No program can consider all of these issues to replace a radiologist within the foreseeable future. The processing power required to figure this out for every clinician’s report would be enormous. Of course, 500 years later, a program may accomplish all these tasks and replace radiologists. But, by then, the same computer will replace every other job, and no trace of humans may exist as the singularity has come and gone! So, for those thinking about entering radiology, keep these issues from dissuading you. Over your career lifetime, you will still have a job!

 

 

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Hobbies For The Radiologist: Are They Just A Fling?

hobbies

Yes, I enjoy radiology. But, a whole world of other pursuits awaits me when I finish work. I may write for this website, learn two different languages (Spanish and Hebrew), play guitar, prepare for the next gig, read about finance, or cook. These are just some of the long-term projects and hobbies that I always seem to fall back on. Yet, I understand that not everyone has the time or inclination for my daily rituals. But, maintaining at least one toe outside the field of medicine is necessary nowadays. And, it is not just about making a paper trail for applications to medical school, residency slots, and radiology jobs.

So, what is it about hobbies and long-term projects that enhance my radiology career? Well, there are a whole host of benefits that come with other endeavors that I enjoy. These include looking at radiology with a fresh eye, reminding me that there is more to life than medicine, finding new friends with differing interests, keeping my brain active/enhancing my energy, and enabling me to transition to a post radiology world. And, these passions may also apply to you as well. Let’s explore some of these reasons to establish a hobby now!

Looking At Your Daily Work With A Different Perspective

Hobbies can allow you to look at the world from a different perspective. For example, instead of dreading waiting for a translator to help translate a Spanish-speaking patient, as a time sink, I look forward to interacting with patients who speak Spanish. It is a way for me to get to learn their culture and get more Spanish practice. Or, as if I am working at home, having a guitar on hand as I’m reading some film enables me to play a little bit while I take a short break. All these different hobbies allow me to look at work from a different perspective.

Hobbies Remind You There Is More To Life Than Medicine

As much as I enjoy radiology and medicine, most of us need time apart from the field so that we can go back to it with a fresh eye. Working on outside projects enables you to accomplish just that. It could be a musical ensemble or a trip to a third-world country. Whatever the case may be, you enhance your enthusiasm for your career when you return to work.

Enlarging Your Familiar Circle

Pursuing hobbies outside the field of medicine can allow the added benefit of meeting other people that think and operate differently from yourself. It is a way to expand your inner circle and make new friends. It’s effortless to stagnate and drift inward as a radiologist, especially for those radiologists that tend not to see as many patients. Hobbies can keep you socially active and engaged.

Keeping Your Brain Active

Radiology can indeed be an intellectual pursuit. But, focusing on anything too much can cause a lack of stimulation. When you branch outside of radiology and medicine, it can keep you more excited about learning and reading. And, this is not just about your hobby, but rather anything else that you pursue, including radiology!

Allows You To Eventually Transition To A Semi-Retirement Or Retirement That You Enjoy

This concept may seem a long way off. But, hobbies you establish today will allow you to do other things the day you decide to partially or entirely retire. Few radiologists can work forever (although I do know a few!) Nevertheless, starting some hobby that you love today is more than a fling. It can become a lifelong mission that you can look forward to in your later days.

Hobbies- More Than Just A Fling!

You may think that hobbies should be the last item on your mind when your days are so busy as a trainee. But, starting a hobby now or continuing with projects from your past should become mission-critical. The best radiologists are happy outside the field the medicine as well. So, don’t forget to pursue other hobbies and projects that you enjoy. It will enhance your career and make you more excited about the day-to-day work!