Keys to Overcoming Initial Inertia at the Radiology Workstation
Certain cases and disciplines can facilitate consistent momentum during the course of the day.
It is the start of a new reading session. I have just settled in front of my workstation and gone through the steps of logging in and firing up the pieces of software that will let me do my job. It is time to pull up my first case. I wouldn’t say I hate it, but I am far from joyous.
It’s not that I dislike my work. Far from it. It also has nothing to do with any particular job I may be holding at the moment. The one I have had for the past 1.5 years has been my best, and I wouldn’t trade it for anything. I actually look forward to it when a weekend or vacay is winding down and am sometimes low-key disappointed when a Friday is wrapping up.
The first case of the day is nevertheless a groaning start. I have no momentum generated from cases before it. There is no wind at my back. It is like taking an initial step of my regular 6.5-mile run or hefting the first shovelful of snow from my very long driveway. I have completed these tasks any number of times. I know that once I get going, I will enjoy them, or at least be happy in my ability to see them through. At the beginning, however, inertia is my enemy.
Any number of things might be dragging at me. It could be that I didn’t get sufficient sleep or had dreams that left me in a less than mood. Maybe the cats knocked a bunch of stuff off the countertop while I was trying to get myself properly caffeinated before work, and I had some unexpected tidying to do (or trashing if they managed to break something). Perhaps I read an email, news item, or social media post that rubbed me the wrong way.
Alternatively, maybe everything went right, and I enjoyed whatever I was doing but had to interrupt the enjoyable thing because it was time to get to work. Shifting mental gears doesn’t always come easily.
Under such circumstances, my mind doesn’t do well with just jumping into any old case. I don’t always have the option. Sometimes, there is a study I am the best suited to read, or urgency demands certain cases go before others. That happens a lot more when, like me, you start working an hour or more before most others log in to their workstations.
That can actually help. STAT cases are often quicker and simpler than cancer follow-ups, and my momentum easily builds with them. Being a per-clicker, it also gets me “in the zone” to rack up some digits in my “completed cases” column, perhaps getting a little ahead of my average pace. For instance, if I know I average six to seven cross-sectionals per hour, having four under my belt in the first 30 minutes (or 2 in 15) gets my morale in a good place.
It is for reasons like that I eschew lower-value stuff like X-rays to ease myself into the reading waters at the beginning of the day. Yes, I can churn through more of them, but it will be on my mind that that handful of extra numbers doesn’t really amount to much. Back when I was salaried or working in jobs where RVUs didn’t matter, that was my favorite go-to for starting a day.
On the other hand, they are still my faves when I am coming around to the last case of the day. I maintain a fairly regimented schedule, and when my reading hours are up, I need to move on to other things. The last thing I want, with five minutes left in my shift, is to open a complex nightmare-o-gram that will keep me at the workstation for another half hour. That won’t happen with XR or ultrasound, which also happen to be feasible if my brain is fried from a full day of work. Plus, if I whip through the case particularly quickly, I can polish off another one or two just like it.
That also works when I am just about ready for my “lunch” break. I put that in quotes because it is a super brief affair. I have found that eating very little helps avoid the postprandial drowsiness that once plagued my early afternoons. It is kind of a wonder I remained awake for the midday conferences we had in my residency, which occurred immediately after folks had a chance to hit the hospital cafeteria.
The other benefit of a super-short “lunch” is that my afternoon doesn’t resume with another first case feeling of zero momentum. After just a few minutes away from the workstation, I can dive right back in.
The “in-between” zone that makes up 99 percent of my workday isn’t all at tip-top, undisturbed gusto, lest that need saying. Complex cases, a ringing phone, or other minor stumbling blocks impact me as if I have been cruising along in the left lane of a highway and catch up to a slowpoke who thinks it is a good place to go below the speed limit. Temporary slowdowns are a normal part of the overall cadence.
Still, it is largely a pleasant blur, a mixture of satisfying capability at my profession and intellectual stimulation when I encounter things I do not thoroughly know. I have mentioned in previous blogs that I consciously avoid staying too rigidly in my “comfort zone,” and reach for cases that I know how to read but don’t get a lot of. A few jobs ago, most nuc med stuff wouldn’t have slowed me down at all, but I have seen less of it in recent years. I am thus a little more deliberate with it nowadays, which doesn’t make it a great first (or last) case.
Occasionally, it makes sense to go exclusively into first-case/last-case mode. If you know you are going to be interrupted, especially repeatedly, momentum has less of a chance to build. I don’t think it is anybody’s preferred way to operate, but sometimes it is the best of limited options. For example, I have some groups use a “hot seat” workflow dynamic. At any given time, one rad is the designated go-to person for all techs and other ancillary staff who have issues.
If you happen to be that individual, and you know your average interval of uninterrupted work is going to be five minutes, I would say it is reasonable for you to cram in whatever case reading you can. Let the “F/U lymphoma” pan scans be taken care of by someone else. Otherwise, you’re liable to require three or more sittings to get through a single case. That is good for neither your mental health nor the care of the patients who cross your path.
