Radiological Sophistication Part Two: Converting the Status-Quo Adversary Into an Ally for Change

Congratulations, you have arrived! Your professional corner of modern society has made it past the survival and inquiry phases. Your hows and whys are mostly sorted. You now transact at the higher level of sophistication, whether you are optimizing efficiency, mini-maxing costs, and benefits, etc. (See last week’s blog for more of an explanation. In that regard, I once more doff my hat to the genius of Douglas Adams.)

It’s not utopia just yet though. Things arise to keep your sophistication train from chugging along. At first blush, they may seem decidedly unsophisticated by comparison. After all, you are an educated, highly skilled individual, boasting years, if not decades, of experience … and someone or something is standing in your way.

Consider some examples from our radiological world. A tech does his scanning in some way that might be convenient for him but is lousy for you and maybe a bunch of other physicians who will want to review the images. A referrer insists on the wrong types of exams for his clinical questions rather than modalities you know would yield a better chance of making helpful diagnoses. The folks making the call schedule can ruin a fair amount of your weekends.

If you value your sophistication, not to mention that of the overall team on which you’re working, you might not take this stuff lying down. Things could be better. Why shouldn’t they be better? So you ask the questions: Why are things being done this way? Can we do things differently?

There can, of course, be sophisticated responses to this. You might not like or agree with them, but you’re not the only smarty out there. Perhaps your personal preferences aren’t the same as others. Other rads doing the same work you do have reasons why the protocols that vex you are good for them. Maybe the techs’ hardware and/or software doesn’t give them the options that you think they have. There is always stuff you don’t know about that can impact the situation and once you’re informed, you might grudgingly nod your head and think “Yeah, I guess things weren’t so clear-cut.”

An awful lot of the time, though, the answers you get are less worthy. “That’s our protocol” is one of my favorites to hate. If you ask people why they do something in a less than optimal way and they say it’s their protocol, they might as well have just said, “I do it that way because I do it that way.” It’s a non-answer, right up there with the parental “Because I said so” that satisfies no kids under any circumstances.

It might not be the “It’s protocol” speaker’s fault. If a superior told them to do things in an objectionable way, they might not know the whys and wherefores. Still, I usually try to get them to say whose protocol it is so I can direct my query to the right place. If they don’t even know who I should go to, that’s a medium-sized red flag for me that someone might be hiding behind bureaucracy instead of standing up and owning one’s policies.

Eventually, I can usually find my way to someone who should be capable of explaining the reasoning behind policies and procedures. If he or she persists with answers like “That’s protocol,” “It’s just the way we do things around here,” “Nobody’s ever had a problem with it before,” etc., I know there is a lack of willingness to look at other solutions.

Alternatively, the person might have an idea of the answer, but knows it’s kind of flimsy and wouldn’t be able to explain why we aren’t doing things a better way. He or she might also be put off by actually having to do some legwork to investigate the current rationale and/or making a show of considering my alternatives, if not implementing them.

Hiding behind non-answers can be an easy way to persist in doing nothing. It works great for politicians and similar figureheads but it’s not worthy of folks in the business of providing health care. This is especially the case for those in policy-setting positions as the things they do impact a lot of health-care providers, not to mention vast swaths of the patient population.

Still, ego and inertia are powerful things, and it’s very easy to make an unhelpful adversary out of the only person who could get your sophistication train back on its rails. If he or she can avoid seriously discussing the issue with you, nothing needs to be done and life remains easy. He or she might throw platitudes at you or offer to “look into it” without addressing the matter. But if you’re too insistent, he or she might reflexively dig in the heels and feel like the existing policy is a hill he or she is willing to die on.

One of the niftier tricks of persuasion I’ve learned about in the past couple of years is getting the other person to come to the conclusion I already have. Instead of saying, “This policy needs to change,” and making my cause something that’s external/alien to him or her, I show the building blocks that led me to my current stance. I point out how the status quo is doing patients a disservice by making my team less sophisticated than it could be.

If I lay it all out for the person, he or she can assemble those building blocks and, suddenly, the idea that policies need to change is an idea the status quo person can adopt and own. If that turns out to be the case, he or she is much likelier to accept “his or her” idea without question and might actually do something about it.