Eric Postal, MD

Radiologists generally seek to have an impact on things. We want to know we are making a difference - in patient care and department protocol.

To sum up my previous thoughts regarding the state of voice recognition typically available to us in radiology: We’re not yet living in the days of Star Trek.

You don’t need to have had personal experience with voice recognition software to know it’s still a work in progress.

In the teleradiology field, I’m partial to working with larger, more established groups, but are there advantages of the smaller startup enterprises?

I get it. You’ve got some issues with this business model, and you feel the need to push back against it.

Previously, I addressed one of the major reasons why I would advise anybody considering telerad to work with a large, established entity as opposed to a smaller outfit: Support.

The government and insurance companies will eventually run out of ways to further complicate the system. Until then, I'd like to suggest some categories of diagnostic codes that we would actually find useful.

Working remotely inherently guarantees that you’ll never get called away from your desk to place an IV, operate a fluoro case, or spend five to 10 minutes in the sonography room because the tech is in over his head.

Whatever the reason, when I got my performance report for last quarter’s radiology work, I found myself musing about the stats used to measure us.

So I took the plunge, and became a teleradiologist.

In our bizarre world of getting paid not for what we do but rather why we did it, we often find ourselves holding the bag when a referrer ordered a study that the insurer decided was “inappropriate.”

The problem with making rules that define cheating is that he who makes the rules needs to have a plan of action to enforce them.

There are chemicals (neurotransmitters and otherwise) central to the physiological process of pain, and I envision an imaging modality that could depict where in the body these chemicals are active.

“Clinical correlation is recommended.” Them’s fighting words, in the right environments. Some clinicians react about as warmly to this phrase as they would to an extended middle digit or an unflattering maternal reference.

I’ve noticed an unsettlingly growing trend, in which I reach a clinician to communicate results of an imaging study on one of their patients… and the clinician refuses to take those results. This is the ugly successor to an older (yet ongoing) issue, in which I can’t get ahold of anyone at all regarding a patient, whether to give results, to better protocol a study, or simply to get some clinical history beyond “R/O pathology.”

So you’ve had enough of seeing your colleagues traipsing through the workload, selecting easy reads while leaving the tougher stuff for you, and you’ve decided to study their tricks - either to counter them, or fight fire with fire. I’m here to help.

As long as the Powers That Be continue to rule that all cases are created equal, and that a normal CT which gets read in three minutes is to be reimbursed identically with a train-wreck CT that takes half an hour and bears a boatload more liability, this will continue to happen.

Is it any wonder that getting physicians to form ranks, toe the line, and obediently comply with subsequently-imposed rules and regulations is a mite challenging? Let alone agree and join together in common cause on matters social and political. Why would you expect them to? This is an entire population of smart folks who spent many years of their lives learning how to gather and assimilate data to arrive at well-thought-out conclusions, ready to defend their reasoning if challenged.

(With apologies to Jeff Foxworthy) You might be a teleradiologist if…

Radiologists, by and large, are rather smart folks. They’ll definitely notice persistent inequities in their workload. If such imbalances aren’t eventually matched by differences in compensation, you can expect one of two things: Your workhorses will find greener pastures, or they’ll realize that the reward for their extra effort is merely the opportunity to continue to pull more than their share in the future - and slow down to emulate the slackers around them.

Yes, going above and beyond will stand you in good stead. Swift and efficient service, subspecialty reads that go the extra mile, and adaptation to the specific needs of your customers are some of the oft-recommended gestures in this regard. To those of us actually doing the work, though, it’s gotten about as trite as old chestnuts like “work smarter, not harder.” If everyone’s doing it, how much can you stand out by doing the same?

A cruel drama is played out every September across the country: Children, already distraught at the end of summer vacation and the resumption of school, are handed their first bundle of homework assignments. And commonly, their beloved summer recess is used against them in the form of a “What I did [or learned] during my summer vacation” essay.

Dear Old-timer, It’s me, the new guy you recently hired for your well-established practice. Even though it’s been a few weeks since you agreed to bring me on board, I imagine you remain uncertain - you must have unspoken concerns about whether I’ll fit in as a good member of your team.

Way back when, during my first year of radiology residency, I noticed a peculiar trend in the department.Well-educated folks, born and raised in the USA with English as their primary language and no trace of a foreign accent, were speaking oddly - but only in the context of metric measurements. Very specifically, the unit which referred to a hundredth of a meter: They called it a “son-timeter.”

I wish I could openly say some of these things to you, but I hope that you already know them on some level. I am both excited and nervous to have you join my practice. On the one hand, I’m hoping this will be a harmonious and mutually beneficial relationship that lasts a long time. On the other, I know how things can go awry, and plan to be very attentive to signs of developing trouble.

Tired of being everybody's answer-man or go-to gal? Somewhere, there are radiologists who prefer to sit quietly at their workstations, cranking out cases to the best of their ability and cringing every time their flow of productivity is disrupted. I'm here to help.

Necessity is the mother of invention, after all. It would only take one or two radiological entrepreneurs to figure out a successful business model for opting out of participation with third parties; others, seeing that it could be done, would likely follow suit. In a way, being pushed to our limit could force us to reclaim control of our profession.

Then you see it - your colleague missed a finding. Something big, something small, something important, something probably inconsequential, whatever. But now you have to decide how to handle it. Especially if the clinician noticed the miss, and is specifically asking about it.

About a decade ago, I was covering a typical callshift at a level-1 trauma center. One of the requisitions for imaging caught my eye. Hastily scrawled in the space for a clinical history was the unilluminating statement: “Patient needs CT.”

A wise physician in the northeast quadrant of the country once commented that a doctor would do well to speak Spanish, act British, and think Yiddish. Whatever his rationale, you’ve almost certainly heard some folks uttering some Yiddish rather than merely thinking it. In case you’ve ever wondered what they were saying, or just want to increase your own repertoire, allow me to offer a sampling. Where possible, I’ve tried to spell phonetically, but some things just have to be heard for full effect. (The sound represented by “ch,” for instance.)