Radiologist discovers his female side as multitasking demands escalate

I didn’t know it until now but if my wife is right, I am, in fact, a woman. She and other women in my life-family, coworkers, friends-all maintain that it is only women who can multitask. Yet there is published evidence that I and all of my male colleagues work in an environment that is interrupt-driven with high multitasking loads. Superwoman, eat your heart out.¹

There is no doubt that it is not just my professional life that is interrupt-driven. I am interrupted when I’m watching football to go and mow the lawn, interrupted when I am doing online research (what is the best site for French wine?), interrupted when I am reading about the Murcielago I will never own, interrupted when I am deep in thought on how to resolve the economic crisis-and no I was not asleep!

Now I have ample evidence to explain why the other behavior driving complaints leveled at all males (we never listen!) is designed specifically to reduce error. No longer can she exclaim, when I point to the errors occasioned in the airline or nuclear power industries as a consequence of interruptions and distractions, “Haven’t seen you piloting too many planes of late. And although you may generate a lot of hot air, we still seem to have pay utility bills!”

“Aha!” I can reply. “Multitasking is bad for patients and interruptions even worse.”² Observations on clinicians demonstrate that doctors are interrupted between six and seven times an hour, that this causes them to spend less time on any given task, and that they fail in nearly 20% of cases to return to the task when they have been interrupted.

Not only can I use this to explain things to my wife-why the garden gate still consists only of the surrounding frame-but also to the chief-I don’t meet my targets because I was interrupted: I forgot to return to the reporting work-list after that idiot from the emergency department burst in to show me his latest triumph of FAST scanning (“Look! An ectopic pregnancy causing ureteric obstruction!!” he shouts before rushing on to the next emergency, my response, “….or a corpus luteum and parapelvic cysts…” lost in the whir of arms and legs-he really should get a cape!).

So. No more interruptions for me! The sign has gone up on the office door and woe betide anyone who enters!

And this is really nice: relax in the solitude and silence, dim the lights, adjust the ambient temperature, make sure the viewing station is at the right height, modify the mouse and keyboard to minimize repetitive stress injury, swear at the voice-activated transcription, and I’m ready for a high-volume, low-error workload. ^3,4

And just to show that I view my consultant responsibilities seriously, the sign on the door also says that I am available for consultation between 8:30 and 9:00 a.m. each day (it’s important that this is during the daily ward round rather than after it has finished!).

There are those within radiology who have adopted this stance. Apparently supported by the literature, they lock themselves away, free from distraction, to carry out their primary role of reporting images. They argue that surgeons would not tolerate interruptions during surgery, that a gastroenterologist would complain vigorously if we were to discuss the finer points of a chest x-ray in the middle of a sigmoidoscopy.

I think they miss the point. While I agree that to be interrupted during a radiology procedure compromises the safety of the patient or during an intimate examination compromises their privacy, the value of a radiologist, as of all doctors, is the ability to multitask, to work under pressure. Much of our work within hospitals is to deal with urgent and emergency conditions, to respond rapidly and accurately to complex and evolving problems. If I am scheduled for image-guided intervention in the afternoon, I wish to discuss the indications and the state of the patient’s health in advance of the procedure. And if this doesn’t happen when I am reporting, then when? During a prostate ultrasound? A joint injection? A defecating proctogram?

What about the “radiologist of the day” approach? I am sure this has many advantages, but if I have reported a study, then it is usual for the clinician to wish to discuss the report with me, unless a second opinion is sought. If the study falls within my area of specialist expertise, then it would be inappropriate to discuss it with anyone else. And if I am to be asked to stick a needle, tube, or stent into anyone, then I owe it to the patient to be briefed properly prior to the procedure. If I am to supervise experienced trainees, I can either pace up and down outside the procedure room like an expectant father or I can do something else productive and recognize that I will be interrupted if the trainee encounters something unexpected that is beyond his or her competence or level of training.

The stance also ignores other evidence for the causes of reporting inaccuracies including workload, lack of clinical details, poor image quality, and, indeed, attention span. Those reviewing x-rays at airport security spend only 20 minutes at a time in front of the screen. Could it not be argued that interruptions, if managed well, might improve our performance?

Until patients form an orderly queue outside my office at the proscribed time, with their ailments properly triaged, then interruptions are an inevitable part of medical and radiological practice.

We must seek to manage such interruptions firmly and effectively, finishing the review and reporting of a study, if the report is almost complete, prior to diverting our attention, or setting aside the study with a brief note of what had and had not been reviewed so that we can return to it later without cutting corners.

If we are not able to demonstrate skills in multitasking, time management, and effective communication, as well as great accuracy in image interpretation, then our roles, as some would suggest, can be divided into individual competencies and performed by an ever growing flock of task-orientated technicians.

….and the garden gate? Don’t tell my wife that it is hidden under a pile of car magazines in the garden shed! I like interruptions …. just not during the World Cup!


DR. DUBBINS is a consultant radiologist at Derriford Hospital in Plymouth, U.K.
 

References

• Coiera E. Clinical communication – a new informatics paradigm. Proc AMIA Annu Fall Symp 1996:17-21.

• Westbrook J, Coiera E, Dunsmuir WT, et al. The impact of interruptions on clinical task completion. Qual Saf Health Care 2010 May 12. [Epub ahead of print].

• Berlin L. Defending the ‘missed’ radiographic diagnosis. Am J Roentgenol 2001;176(2):317-322.

• Stephens S, Martin I, Dixon AK. Errors in abdominal CT. J Med Imaging 1989;3:281-287.