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What is the Proper Modicum of Caring in Radiology?

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Does experience soften one’s threshold for pushing back against extraneous imaging protocols and other slights in radiology?

I have been doing the home-based teleradiology thing for over 13 years now. That is well over half of my post-training career. While I can still remember what it was like to work onsite, I don’t miss it.

Back when I was onsite, we didn’t have any need for communications tools like Microsoft Teams. If you needed to talk to colleagues, they were right there, or close enough. Technology wasn’t quite where it is now, and computing power, bandwidth, etc., were not to be carelessly wasted on fripperies. For that matter, Microsoft Teams hadn’t even been made yet. I couldn’t tell you if any similar software existed at the time.

Telerad is a much different animal. Nobody is in the same location, and picking up the phone every time you want to communicate is just plain clunky. There are now many group messaging apps, and they provide way more function than most of us could have predicted.

In addition to more directly utilitarian value of these things (asking for curbside consults, technical troubleshooting, etc.), many rads benefit from just being able to blow off steam or otherwise shoot the breeze with colleagues via IM from their workstations. This past week, one of my virtual mates shared some confusion (and maybe a little frustration) over imaging protocols from an ER. Should they be ordering study X for scenario Y? Should we be pushing back on it?

As something of a hired gun telerad who is there to clear the lists but holds no rank in the group, I didn’t feel it was my place to speak up with opinions about how to corral their referrers. Heck, I don’t even know who in the chat is an actual member of the local group as opposed to another contracted outsider like me.

Nevertheless, as the guy’s chat query sat there and minutes rolled by without anyone answering, I found myself envisioning him pining away for a response and feeling ignored. Accordingly, I piped up to sympathize about seeing studies being ordered inappropriately, but also mentioned that my 20-plus years in the field had softened me up to the point that I am less likely to fight the good fight than I used to be. Scans tend to get done one way or another, and resisting might hurt you.

Whether or not my bit added sufficient kinetic energy to get the conversational ball rolling, others finally chimed in, and I faded into the background as I felt was proper. (Again, they have me there to help clear the lists, not because of my charming personality.) Still, I get alerts when others comment, and curiosity impels me to follow the chat when I am in between cases.

It proceeded as you might expect with rads talking about the protocol at hand as well as the larger issue of folks ordering studies without necessarily exercising good judgment. Inevitably, that included shared frustration over things like being on call for a weekend and getting a series of whole-body scans on geriatric patients for “possible fall from standing.”

I couldn’t help notice that, by and large, the other rads seemed to care more about this stuff, and were more willing to push back against it than I. That was surprisingly at odds with my self-recollection of years passed by. I felt like it wasn’t too long ago that I would been among the first to gather up torches and pitchforks to go storm the Castle of Inappropriate Imaging.

Maybe it is just that I am happier in my career now than I have ever been before, and my baseline is further below a “call-to-arms” threshold? Alternatively, perhaps I have just banged my head against the wall for long enough that I have beaten myself into submission. It would be a little too self-congratulatory to chalk this up to maturation and earned wisdom, right?

Whatever the mechanism, I figured that a similar trend probably hits a lot of other rads as they rack up years in the field (except maybe for some lucky souls out there who achieved Zen early in life and never got their gums in an uproar to begin with). Folks like me, early on, have an excess of caring about things that either aren’t worth caring about ... or things which aren’t likely to be fixed no matter how much we care about them.

We eventually adapt by caring less, a la George Carlin: If your needs aren’t being met, drop some of your needs.

This trend can go too far. We medical types are, after all, supposed to be somewhat motivated by caring for people (hence health care). There is a level of caring below which docs, nurses, etc., become so jaded that we would be better off with them out of the field. That is a big chunk of why we were all hearing about the dangers of “burnout” a few years back. If we let too many folks prematurely burn away their care, we will wind up with worse shortages than we already have.

Coincidentally, while I was writing this blog, someone on a rad social media channel just posted: “Is there an RVU conversion factor for compassion? Just asking for a friend.”

Motivated by such a thought, I commented in the Teams thread. When a rad gets to the point of not even having a slight reaction to garbage cases that shouldn’t have been done, he or she might be ready to be pushed into retirement. As long as I get irked at stuff like “R/O sepsis” as a reason for imaging, I know I still have a pulse.

Of course, that is not a real litmus test, but the bar isn’t unfathomably lower. There have been times I have witnessed rads senior to me displaying such a lack of caring that I have thought, “Please, God, if I ever get to that point and don’t recognize it, toss a minor miracle to take me out of the field.” Whether it is ignoring blatant pathology (or realizing you missed something huge and not being properly embarrassed/humbled), making light of patients’ misfortune, or maliciously mistreating fellow rads, I have seen examples of this but try not to remember the details of their ugliness.

I think I have settled into my happy medium, my “proper modicum of caring” to putter along in this field for a long time to come. I still get vexed from time to time, but I think it is for pretty reasonable stuff (“That referrer acted like a real jerk,” or “Why doesn’t technology work better than this?”). Most of the stuff that used to grind me down doesn’t show up on my radar anymore, and I am glad about it.

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