Perspective with Radiology Gigs: You Can't Fix Everything and Sometimes, You Can't Fix Anything

Each month, the university I attended for undergrad sends an alumni mag. I glance through it, usually seeing nothing of interest, and into the recycling bin it goes. This time around, there was a promising piece about physicians and “self-care.” The article failed to deliver so the bin’s meal was only delayed by a minute or so. In transit, however, it got my mental gears turning.

You might have gathered from previous blogs that I take the concept of “physician, heal thyself” seriously. More specifically, when we know from our education/training that an ounce of prevention is worth a pound of cure, we look bad if we fail to self-apply that wisdom. Even if we don’t care enough for ourselves, it doesn’t inspire much confidence in patients if they see us failing to eat properly, exercise, and all the other good stuff.

Idealistic docs, especially greener ones, get frustrated when they are unable to motivate patients to do right by themselves. Here we are, laying out a lifestyle for them that will help avoid hypertension, diabetes, cardiovascular breakdown, etc., and nobody seems to listen. Meanwhile, other patients further down the self-neglect pipeline are non-compliant with their diagnostic and therapeutic regimens and appear to willingly accelerate their self-destruction.

To put this another way, a lot of docs see ways they should be able to fix things and find themselves unable to without a satisfying reason. Indeed, the proportion of stuff we can actually fix dwindles to the point of vanishing.

Compounding that is the experience of subspecialists such as radiologists. We see referring clinicians — including other docs — who theoretically want our assistance, but then impede our efforts at helping them to fix things.

We receive a chest CT, for instance, following minuscule lung nodules that have been stable for many years, and note that the patient has no background of cancer or significant risk factors. We spell out that there is no need to continue following and radiating the patient. Months later, we see another follow-up on our worklist anyway.

We get an X-ray or ultrasound showing a suspicious lesion and suggest more advanced imaging to confirm. The next thing we know, the patient has a “follow up” X-ray or ultrasound the next year, and the lesion is now a huge honkin’ mass accompanied by metastases.

Sometimes, surely, there are factors of which we are unaware that would make the referrer’s actions more reasonable if only we knew. Of course, sometimes it is not the referrer at all but the patient. If you have never had a BI-RADS or Lung-RADS category 3 patient who failed to comply with recommended follow-up imaging, and later wished he or she had, count yourself fortunate.

The “I could fix this, but I’m not being allowed to” phenomenon goes beyond the clinical. Most of us see avoidable logistical messes in our jobs far more frequently than we would like, often the same things repeatedly going wrong. We bang our heads against the wall trying to bring about corrective action, or we learn that leadership lacks interest/resources to make improvements, so we huddle down and endure it, trying our best not to care so much.

Being physicians, we are liable to have stronger feelings about making things better and might bang our heads against the wall that much more forcefully or persistently. Further, as diagnosticians in radiology, we’re that much more likely to analytically size up situations and recognize what needs to be done about them. At least,we believe ourselves more capable of it, thus deserving to be taken seriously when we identify key problems and/or propose solutions.

I have mentioned in previous blogs that my CV has greater lineage than most on account of leaving jobs gone sour for greener pastures. It was never a spur-of-the-moment decision. Each time, it followed months (if not years) of trying to make things work in what would ultimately be my former gig. In other words, I wanted to fix things.

They always seemed fixable. The remedies I saw were quick and easy, and cheap to implement if not free. I also wasn’t the only one who stood to benefit: The things I wanted to fix would have helped other rads, and possibly attracted better new recruits. I could point out ways my ideas would benefit the group as a whole, including leadership and, God forbid, patients as well as the referrers sending them.

If leadership perceived obstacles to those fixes, they never spelled any out. Often, the response would be a form of “ghosting,” wherein they would make some vague comments about looking into my proposals but never circle back on them (or make more vague comments when I reintroduced the subject). It was hard to come away with anything but a strong feeling that they just didn’t want to make the effort or had motives more nefarious.

The one thing I could fix in such circumstances was myself. I could get out of the dysfunctional setting and go somewhere that did better.

There was always hope of fixing a little more. Maybe, by “voting with my feet,” I would finally get it through to leadership that their inaction was costing them people, and they would do something. Staying in touch with former colleagues, I always hoped that I would hear good tidings in this regard. One might imagine some evil satisfaction in hearing that the bad gig I escaped continued to be bad (or worse) after my departure, and that I had made the right move by not sticking around. However, I did not relish the thought of suffering by my good teammates who chose to remain.

One other fix does occasionally present itself. Sometimes, by maintaining contact with a former colleague at a gig I left, I can help when the colleague decides he or she has had enough too. It happened just this past week. I made the introduction to my current group’s leadership, and it looks like he may come aboard for better times. Helping to fix his situation is gravy on top of resuming work with an old pal.