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Are You Captive to Your Capability in Radiology?

October 21, 2024

Blog

Article

There can be a thin line between providing extra effort in a team setting and overextending oneself to compensate for the shortcomings of others.

I have a couple of projects I am trying to get done around my house before winter hits. They are not huge undertakings, but they are the sort of things that require more than one individual other than me. For example, one project may involve an electrician and a painter.

It is a rare pleasure when I can get such third parties to communicate directly with one another rather than relaying messages through me. Each extra point of contact in the flow of information is another opportunity for things to break down: Stuff is poorly conveyed or misunderstood, messages go unnoticed or forgotten, people go on vacation, flake out, vanish, etc. Such breakdowns, I think, stick in my craw a little more readily than they do for a lot of folks.

I am not impatient under most circumstances, but one of my characteristics —call it a strength, a quirk, or a neurosis — is that I respond to things like a shot. Email me a question and, unless I am thoroughly immersed in another task, you will probably have my answer before you look away from whatever device you used to send it. I have had more than a few credentialing staff comment on the immediacy with which I complete and return their DocuSign items.

It is not that I expect everyone else to adopt my Minuteman ways. On some level, though, it does seem reasonable that anybody transacting as a mature (especially professional) adult should have some sort of system for reliably closing loops. If your mechanism isn’t to immediately do whatever lands on your desk, perhaps you can routinely have the last or first chunk of each day set aside for tidying up loose ends or planning their settlement in the visible future.

Having that attitude sets me up for some disappointment as there are a multitude of unreliable, disorganized, or simply overtaxed people out there, and they cross my path on a regular basis. After a fashion, I become a captive to my own capabilities. I don’t necessarily take it in stride when they fail to live up to my expectations, yet I still feel the need to be at my reliable best toward them, maybe even better, if possible, to make up for their failings.

It reminds me of something a colleague said a few years ago. He was feeling particularly frustrated at a lack of ability or effort from folks in his radiological orbit. Referring clinicians, techs, physician extenders routinely screwed things up or just “mailed them in,” and he wound up feeling a need to overperform to the point where he would singlehandedly make up for their deficiencies. I no longer recall his precise words, which is a shame because they were well chosen. It was something like “When did it become my job to do everyone else’s?”

I suspect the prevalence of such self-captivity increases in proportion to capability. An unassuming handyman with a healthy sense of humility might be less susceptible than, say, a competitive go-getter at the top of class in university and med school with high percentiles on exams, desirable residency/fellowship, etc. For that matter, another handyman with a more aggressive attitude (I am going to outcompete the other handymen by being better at my job, I will be super reliable, I will create my own business empire) would be at greater risk than his humble counterpart.

Being in a field like radiology (or, indeed, most of health care) adds more layers inducive of capability captivity. 360-degree oversight, including peer-review, is robust to the point of being overbearing. One can perceive a constant low-level threat to professional viability, a sense that even the slightest imperfection might lead to permanent black marks on one’s record. Worse, it is far from unheard of to be held accountable for someone else’s blemishes. Like my former colleague above, it is easy to feel a need to self-appoint as the world’s quality control.

For Related Content

• “Big Radfish in Small RVU Ponds: You Have No Idea What You Are Capable Of”

• “How I Learn or Don’t in Radiology”

• “The Ubiquity of Gell-Mann Amnesia in Radiology, Health Care and Beyond”

Suppose you are superhumanly Zen about such things or blessed to work in circumstances with more reasonable oversight systems. The same world of imperfection surrounding you still threatens to make your profession, even your own rad group, look less wonderful than you know it should. Even if you are blissfully unconcerned with that, there is still the matter of quality patient care you (hopefully) want to provide. If you had the sense that your hypervigilance could improve outcomes in just 1 percent of the cases you saw, it would be awfully hard not to act on that.

One simple way to avoid a lot of this angst would be to remove yourself from situations in which your capability is outsized. That is, if it seems that the people and institutions around you are constantly falling short and forcing you to pick up the slack (or at least stress about it), go surround yourself with better people and institutions instead. In our line of work, telerad has made this a lot easier. It has done wonders for me.

Unfortunately, the imperfection of mere mortals is everywhere, and escape is unlikely. A remedy might therefore have to come from within.

If, for instance, one was to recognize that maybe he or she isn’t quite so superbly capable, but rather has an overinflated sense of capability, the fix would be straightforward. Find ways to be more realistic in self-appraisal. Self-demoting a few pegs could be all that is needed to escape from self-imposed captivity.

Various types of coping and stress management would be alternatives. Make the “serenity prayer” part of your daily routine, meditate, even get some therapy if you need it.

Some high-performing individuals take the opposite approach and embrace the situation. If you proposed my “captivity” frame to them, they would probably reject it. They might instead take a page out of comic books, a la Spider-Man’s “With great power comes great responsibility.” They rightly consider their capability as a gift, one that can be shared for collective benefit. Sure, it has its negatives, including added personal stress, but the benefit far outweighs the cost.