Forgetting More Radiology Than You Will Ever Know

I remember when remembering things was a bigger deal.

Growing up in a time when most people didn’t even have a desktop computer, let alone the more advanced tech we have now, I saw memory having far greater importance. To effectively know something, you had to be able to retrieve it from your own noggin.

There were some crutches. You could jot down some notes for future reference. You might keep address books and calendars to track contact info and appointments. That didn’t help much, however, if you wanted to know something when you were away from your resources.

It was the same deal if you knew exactly where you could look up a needed factoid. Unless you happened to be near your encyclopedia set or a handy library, you were no better than someone who had never known of the factoid’s existence.

Once computers came along, especially with the Internet, a lot of that went away. There was still a chunk of time when you might have said things like, “I’ll have to look that up when I get to a computer,” but even that stopped being an obstacle once everybody had cellphones and the world was blanketed in WiFi.

Now we have portable accessory memories. There’s no need to learn things by rote when you can look them up on a whim. Without having to practice the skill of memorization, I think that mental muscle has atrophied (or never developed in the first place) for a lot of folks.

An ever increasing fraction of the population doesn’t really know what it was like, having to commit things to memory other than maybe to pass an exam in school. This may not even be the case for many people. I wouldn’t be surprised to hear that more testing is “open book,” since that depends on comprehension of material rather than an ability to regurgitate it.

Memorization was still a big deal for me throughout my radiology training. One needed to know common differential diagnoses, normal measurements, and other various numerical values. Otherwise, one would constantly go looking for reference texts, which would be a hassling waste of time. The aggravation might serve as its own motivation. “This time, I’m going to remember so I never have to look this up again.” This holds true until, of course, the next time one needs the info and still doesn’t recall it.

The problem is we have a vast body of knowledge we’re trying to maintain. If we’re not narrowly subspecialized, some of the tidbits of info don’t come into play all that often. If most of what I do is body imaging, and once in a blue moon I get an ultrasound for pyloric stenosis, I am never going to remember what the normal values for length/thickness are no matter how many times I look it up.

Before a gazillion reliable references turned up on the Web and we all had more bandwidth than we could ever need, I started jotting down some of my more frequent memory offenders, and taped or tacked them to the wall of my reading room. Nobody else used the place, and I wasn’t decorating otherwise. I had tables of normal organ sizes in pediatric patients (adults were easier to remember since they’re more uniform), appropriate caliber for various vessels, the chart for assessing carotid stenoses, etc. It was quite a little collection. Instead of going over to the bookshelf and hoping I could find what I needed quickly, I could just turn my head and there it all was on the wall.

There are some things I might claim to know but I still catch myself sometimes running through mnemonics I used in med school, and a twinge of embarrassment hits. For example, for the carpal bones, every time I start mentally reciting “Scared Lovers Try Positions They Cannot Handle” just to besure I am properly talking about the triquetrum,I feel like a bit of a dunce. It is like having to mentally recite my ABCs when arranging things in alphabetical order.

One of my med school profs, an elder British schoolmarm type, put it nicely. She repeatedly urged us not to fret about learning everything so indelibly that we would have it all at our command at a moment’s notice. Instead, the key was to learn things well enough that they’d reliably be found in what she called the “cobweb” section of the mind. You don’t specifically remember X, but you remember that you knew it, and with some time/effort, you can dredge it up.

From that perspective, you have learned (and forgotten) more than you will ever know, radiologically or otherwise. You’ve probably heard about the “magic number” of items you can hold in your short-term memory (7 +/-2). Even the harshest self-critic would admit that she or he learned vastly more than five to nine items before getting very far in life. At any given moment, you “know” a small handful of things. Anything beyond that takes a moment to bring back to your consciousness.

I like to think of short-term memory as a loading dock in front of an impossibly huge warehouse. Your conscious self dwells in the dock’s relatively small space as the world brings various things by the dock. If you remember them at all, they get brought into the warehouse but how you bring them in determines whether you will easily retrieve them later.

For instance, perhaps you are “bad with names.” In a social situation, you meet a handful of people but know that it will only be a matter of minutes before you have no idea what to call any of them. The names showed up on your loading dock, but you dismissively had some of your warehouse goons bring them in and toss them in some corner or other. Good luck ever retrieving those.

Now imagine you are in radiology residency. You’re trying to learn an awful lot of stuff but when a neuro attending tells you the MR signal characteristics for various stages of intracranial bleeds, it strikes you as particularly important. You make a special effort and have your warehouse people carefully bring in that info so you will be able to summon it back to the loading dock in a jiffy. Perhaps you earmark it with a funny mnemonic to make sure.

Could you be a little embarrassed to think that 20 years later, you’re still using that memory trick when you look at scans? Perhaps. However, for all you know, the best radiology wizards are doing exactly the same thing, since their loading docks are no larger than yours.

Let’s put it another way. If a radiologist interprets an imaging study correctly, do you really care whether the rad did it unassisted, aided by a nursery rhyme mnemonic he or she learned in med school, or because the rad remembered enough to look up a detail from a reliable source?