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Is Radiological Efficiency a Benjamin Button Phenomenon?
Does the wisdom of experience to make meaningful changes in radiology get usurped by reduced energy and a sense of diminishing returns?
It doesn’t take very long in a radiological career to see that we haven’t a lot to complain about. We somewhat make up for that by rehashing the same issues over and over.
That recognition comes a lot faster if you pay attention to social media. It crowdsources our collective woes and, occasionally, solutions. An individual might only gripe about something once but keep on watching and you will repeatedly see others raise the same point.
It doesn’t matter if other rads commiserate that nothing can be done about the issue, resoundingly rebuke the complainer that his problem really isn’t one or offer the most brilliant solution ever. Sooner or later, a different group of rads will be in another thread talking about exactly the same thing. Intermittently, someone comments to the effect of “this has been asked and answered a thousand times!” That rad will be considered a grouch and largely ignored.
One such thread, this past week, regarded the issue of could have been avoided addendum requests. Imaging winds up on the worklist without a prior study for comparison and the prior only magically appears after the case has been read. The rad has to go back and reinterpret the case. That can be a big nothing or it can be a nightmare if it’s a “restage lymphoma” pan-scan.
I have written about this issue before, and won’t delve back into its weeds, save to say that most rads experiencing it are less than thrilled with the inefficiency of it all. The addendum obviously has to be done once the mess has been made, but the process sparks thought about how the situation could have been avoided and might be prevented from recurring.
The rad involved (including me more than a few times) might be motivated to push for changes. Maybe he or she is seeing red at having spent half an hour on this nightmare case to begin with, and now potentially doubling that without seeing an extra penny while the rad’s workload of the current day continues to pile up. Alternately, maybe the rad is entirely calm about it, but sees a better way to do things and wants improvement for him- or herself, colleagues and rads yet to come.
Not everybody sees such situations as opportunities for change. Some rads express a more stoic (or fatalistic) attitude, noting in the aforementioned social media threads such: “Stop complaining and just do the addendum.” They seem to be of the attitude that our field is full of imperfections that cannot ever be set right, and we might as well all grimly accept it as we plod toward retirement. I get the impression they are not a lot of fun to hang out with.
I have noticed a certain progression as folks wend their way through their careers. Early on, one might be full of energy and high ideals, eagerly crusading for health care to be executed the way it “should.” As time goes on and the real world takes its toll, that energy diminishes, and those ideals get a little tarnished. One sees that there is only so much one can do, and comes to accept, if not embrace, the world’s imperfections. Choosing battles replaces tilting at every windmill in sight.
What does not accompany that initial oomph to fight the good fight is experience to know what is worth fighting for. A newbie rad who gets a pan-scan addendum request might immediately recognize that he or she doesn’t appreciate having to do it, but it will take some iterations and/or years before he or she is likely to think of all the reasons why one should never have had to read the study without priors in the first place. It might be even longer before there are any proposed workflow changes that would fix the issue.
These two trends move in opposite directions as a rad gets older and more seasoned. Wisdom about what improvements are desirable and achievable increases while the will to use that wisdom ebbs. One might imagine they would balance out but there is another trend in play: diminishing returns.
Even as the increasingly senior rad becomes aware of how things could be improved if not entirely fixed, he or she is more and more mindful of how the clock is ticking on his or her remaining time in the field. Coupled with reduced vim and vigor, this makes him or her less likely to push for change. The net effect is regressive, reminiscent of Benjamin Button.
Suppose, for instance, you told me at the beginning of my career that I would have 100 pan-scan addenda to do in the coming decades, all because nobody had a good strategy for getting relevant priors in advance. Looking ahead at literally hours of my life that stood to be wasted, I would charge the issue head-on.
Now, suppose it’s midway through my career. You tell me I have 50 pan-scan addenda left in my future. That is still an unpleasant thought, and I am motivated to do something about it. However, I have already been softened up by the first 50, plus everything else that has worn on me. I will probably still make the effort, but it will take less resistance from the Powers That Be to make me give up.
Fast forward some more, and I am eyeballing retirement. You tell me I have perhaps 10 pan-scan addenda to go. Yes, I remember the aggravation of doing the previous 90, and I would rather not do any more but is it worth my while to take this on now? Would the time and effort to fight this battle be less than it would cost me to just do the remaining 10 exams?
It occurs to me this might be a strength of academic-setting radiology wherein elder statesmen rads with maximized experience are routinely paired with young spitfires in or just out of training. Of course, the main focus of such pseudo-apprenticeship is to convey diagnostic and procedural knowhow, but a typical day never consists of 100 percent clinical work. There is plenty of room for “how the world works” and talk of how to change it.
Light the right fire in the younger folks’ bellies, and they might just take up the causes their mentors wouldn’t see through.
