An Easier Climb Back Into the Saddle

Winding down my first vacation in about 1.5 years, I found myself bracing for impact as I resumed my normal working hours—which isn’t new for me, but it’s diminished over the years as I’ve “traded up” from one job to another.

I expect it’s almost a universal phenomenon, unless one happens to be deliriously happy in one’s vocation, such that one would do it even if financially independent and needing no income, returning from a break is always going to have unpleasant aspects. Having to get back on a regular schedule, living up to responsibilities rather than doing whatever seems like momentary fun, and of course things that telerads like myself have shelved (dressing professionally, commuting).

Back in early residency, a week away had a jarring impact on my newbie radiology skills, I recall sitting at the chest X-ray alternator with a somewhat-anxious sense of “how do I do this, again?” Now, with 20-plus years of practice, I can barely conceive of feeling that way. Maybe if I took a whole year off? Perhaps not even then; rads might be permanently etched on my brain by now.

After training was done and I moved on to private practice, I encountered new wrinkles in post-vacation pain, which felt like punishments for having taken time off. I’d walk in the door of my workplace and it would be like a series of booby-traps had been set to “welcome” me back.

For instance, there would invariably be an extra-big stack of studies piled up for me to read, having accumulated in the days I was away. I wasn’t the only one capable of reading them, but I might as well have been. Sure, things might have been busy in my absence; maybe the rads covering my spot just couldn’t get to everything, but I always got the feeling of reading most of the studies I would have if I hadn’t been away at all.

Also accumulating in my absence would be a number of referrers wanting to talk about studies I’d read, or asking for addenda to my reports, for instance because only after I’d read their cases had they bothered to provide CDs of previous scans at other facilities for comparison.

I couldn’t blame the other rads for not wanting to handle these things—I read and knew the cases, whereas they’d have to start from scratch and hope they didn’t disagree with my interpretations. Most practicing rads will know, however, that many of these addendum requests are pure time-wasting garbage.

(An example I heard about on my first day back, from another rad: Some provider wanted an addendum on a thyroid ultrasound because it was reported with measurements in centimeters—they wanted an addendum to describe everything in millimeters instead.)

When I moved on to telerad, the phenomenon of piled-up cases went away; the per-click model centers on always having a full worklist for the rads. Anything I wasn’t around to read would have been picked up by some other hungry individual. Even some of the “clinician wants to talk” and addendum requests got handled, perhaps by vRad’s section-heads. I mean, if anybody were to take the risk of disputing/overruling my reports, someone in their lofty role should fit the bill, right?

vR’s system introduced new post-vacation punishments, however. I’ve previously written in this column that their QA left some things to be desired, one of which being that you’d find out you had problematic cases when you first logged in for a shift. A tab at the top of their RIS-page would be an ominous red, and you’d have to click on it to see a list of accusations against your competency/conscientiousness. The longer it had been since you’d last logged in, the more time there was for that list to populate.

Maybe it’s my psych degree talking, but it seems to me that punishing someone every time they come back from vacation is not a great way to make them feel good about the job to which they’re returning. It would probably be better to find ways to ease their climb back into the saddle. Even make it pleasant, if at all possible.

Circumstances varying so widely between radiology practices, there’s no one-size-fits-all solution to offer. I’d start by simply asking around what the various rads found troublesome when they came back from a break, and find remedies for the complaints.

For instance, in groups like my pre-telerad jobs where backlogs of work develop and a returning vacationer tends to be greeted by a stack of studies earmarked for him: Put him on a non-demanding rotation for his first day back.

Your group has forced him into the position of playing catch-up, so don’t interrupt that by whatever usual parade of STAT-reads, fluoro cases, diagnostic mammos, contrast injections, etc. would ordinarily chop up his day. 

If you have daily productivity quotas, maybe relax his as he deals with a bunch of accumulated addendum-requests and returns calls to a gaggle of referrers. Unless of course your system has a mechanism for counting such activity as pseudo-RVUs.

Err on the side of overcompensation; making folks’ first day back at work exceptionally easy is better for their morale than not making it easy enough. If they happen to not come back to too much of a mess, or otherwise get caught up early in the day, they can always take more upon themselves. An appreciative demonstration of teamwork: “Thanks for the assist, but things are pretty good here; put me back at full capacity.”