Let Yourself Be Pleasantly Surprised

Awhile back, I found myself in an instant message (IM) volley with a colleague about some case as to whether it was readable. Not worth going into details, since most rads have surely had the same experience:

Some aspect of the study or its priors is lacking juuuuust enough that you’d be reasonable to send it back for fixing…but you might look like a stickler, and it wouldn’t do anything to clear the worklist. Or you could “tough it out” and read as-is…but you’d be taking on a theoretical iota of liability, and some nitpicky individual could find fault with you for cutting corners, however small.

Anyway, the IM chat had begun with a “should I read this?” tone, but the subject being imperfect studies, it was all too easy for things to morph into a griping-session about the radiological world generally not living up to our high standards. Which might have been amusing for an outsider to watch, since neither of us had highfalutin’ titles or Ivory Tower credentials to back up such talk.

As the messages continued to go back and forth, I’d moved on with my work, opening an ultrasound from a facility that had been the subject of more than one previous episode of such bellyaching…and, much to my surprise, I was darned impressed by it.

It was a non-vascular extremity sono in the setting of cellulitis, checking for abscesses. It showed the usual edema and hyperemia, but nothing drainable. And then, mixed in with the ultrasound images, there were a couple of color photos of the patient’s actual leg, so I could see the localized swelling that had prompted clinical suspicion.

I have no idea whether it was the sonographer’s innovation to do this or some higher-up who had enacted a new policy. Whichever, it was definitely “outside-the-box” thinking. I had never, in a decade of reading telerad, seen anybody else sufficiently motivated to do this (including figuring out how to attach a digital photo to a series of sonographic images on PACS).

Found myself feeling a little bad about all of the negative sentiments I’d had about that facility and/or its sonographers (though they’d certainly done things to earn that displeasure) and hopeful that they were improving. I made sure to include a statement or two in my report so they’d know I’d seen the photo and that it had added to my interpretation.

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It could have gone other ways. Another rad might have seen the photos, thought they should be standard-of-care, and been thoroughly unmoved in his estimation of that sono department while incrementally further unimpressed with all other facilities that were not including photos. Or a rad might have seen no point to the photos, considering them a waste of his time and bandwidth. Even irritated that he would now be on the record as having seen them and responsible for whatever they showed.

A lot of rads (and people in general) have become sufficiently jaded, cynical, and/or embittered that they aren’t really open to being pleasantly surprised in their daily grinds. Maybe it’s a learned defense: Don’t let your hopes and expectations get raised, lest they be painfully shut down later on. Or they don’t want to appear naïve and optimistic, preferring a seasoned-veteran “I’ve seen everything and none of it impresses me” demeanor.

I think that’s a mistake for a few reasons. First and foremost being that there’s enough negativity and mirthlessness already – why choose to harden yourself against pleasant exceptions to that norm? If your typical workday could have a handful of “gee, that’s nice” or “gosh, that’s neat” moments in which you’d be pleasantly surprised by things, why wouldn’t you want to have those episodes boosting your morale?

Second: As a good Jedi once said, your focus determines your reality. The more you exclusively attend to the negative stuff, the less you’ll notice and appreciate the positive things. Even if they hit you in the face, you’ll be more likely to see them in negative ways, a la glass being half empty instead of full. I wrote a piece about reframing a little while ago. Frame your reality to include more pleasant things, and soon it’ll actually seem like more good stuff is coming your way…and you’ll be that much more aware to enjoy and take advantage of it.

Third: Letting nice things happen to you, and especially being vocal about them, is way more appealing to your colleagues and everyone else who has to deal with you. Sure, Eeyore had his charm…but would you rather hang out with him or Tigger? More pragmatically, who do you think is going to be considered first for desirable things like promotions and plum assignments—someone who seems capable with identifying opportunities and other good stuff when they’re to be found or Debbie Downer?

Follow Editorial Board member Eric Postal, M.D., on Twitter, @EricPostal_MD.