Eric Postal, MD

Then you see it - your colleague missed a finding. Something big, something small, something important, something probably inconsequential, whatever. But now you have to decide how to handle it. Especially if the clinician noticed the miss, and is specifically asking about it.

About a decade ago, I was covering a typical callshift at a level-1 trauma center. One of the requisitions for imaging caught my eye. Hastily scrawled in the space for a clinical history was the unilluminating statement: “Patient needs CT.”

A wise physician in the northeast quadrant of the country once commented that a doctor would do well to speak Spanish, act British, and think Yiddish. Whatever his rationale, you’ve almost certainly heard some folks uttering some Yiddish rather than merely thinking it. In case you’ve ever wondered what they were saying, or just want to increase your own repertoire, allow me to offer a sampling. Where possible, I’ve tried to spell phonetically, but some things just have to be heard for full effect. (The sound represented by “ch,” for instance.)

During the national debate over our ballooning debt, there has been a fair amount of talk about entitlements. In that context, “entitlements” refers to social programs such as Medicaid, Social Security, disability, and the like - programs intended to help members of society who are less fortunate and more in need. It is not uncommon to hear a disparaging tone from those speaking of entitlements, particularly when the speakers are paying into the system but not receiving benefits from the programs.

As a radiologist (or, indeed, any kind of physician), you are a professional. You have completed at least two decades of education, including an advanced degree. You have not just passed but scored very competitively on numerous exams, held up under scrutiny from dozens of educators and interviewers, and committed yourself to maintaining your clinical edge by keeping current with academic literature and educational conferences.

Every now and then, I find myself thinking about some of the skills radiologists have developed that are underappreciated. Some once held more importance than they now do (pneumoencephalography, for instance). Others were more recently of practical value but are on their way out, and some show no signs of leaving us.

Every now and then, I find myself thinking about some of the skills radiologists have developed that are underappreciated. Some once held more importance than they now do (pneumoencephalography, for instance). Others were more recently of practical value but are on their way out, and some show no signs of leaving us.

Unless you’ve been living under a rock, you might’ve heard about a need for cost-cutting in health care. Our esteemed politicians tell us that all options are on the table, and that they’re looking for ideas. Just on the off-chance that they actually mean it, here are my favorite three.

Remember your education in physics? No, not the stuff from your radiology residency; I’m talking about undergraduate classes, or even earlier. Chances are you thought more than a couple of times about how irrelevant this stuff was going to be, once you got into med school. I know I did.

Finishing my review of the gazillionth abnormal CT for the night, I phoned the hospital’s operator to get me in touch with the clinician for the patient. The operator could tell from my voice just how beaten-down I was; before connecting me with the doc, she wanted to know if she could ask me something. I grunted permission. “Do you have a sense of humor?” she wanted to know.

It seems to me we should play to our strengths, and use our gear and knowhow to tap into some lucrative, unregulated markets.

Once upon a time, there was an industry which provided a highly useful and in-demand set of products and services. Virtually all members of society sooner or later made use of the industry, and most would be repeat customers. The industry steadily grew, increasing both the variety and sophistication of its offerings.

In many of these instances, the search for prior films is fruitless, for the patient had no prior study after all. The culprit turns out to be the doc (or nurse) who wrote out the script; the individual always writes “please compare with priors.” Just in case there are any.

Consider appointing some troubleshooters, who can be on the lookout for problems before they snowball out of control, are ready to pinch-hit for coworkers who see trouble brewing, and follow through on issues to make sure they were really settled.

Using worksheets may introduce malpractice concerns and errors, but they also can help make sure the tech captures what is needed.

There are few buzzwords likelier to get a strong reaction from radiologists than the one mentioned above. Bring it up, and folks can get animated, agitated, or downright angry. Part of what makes this such a tinderbox is that “teleradiology” refers to a heterogeneous group of entities, and it’s easy to dismiss them all with a single condemning sweep of the hand.

“I don’t know” is grossly underutilized. In medicine, particularly the diagnostic specialties, it can be very difficult to utter.

Our physician blogger lays out a taxonomy of colleagues

It feels momentarily better to tell off the people who drive you mad, but it otherwise doesn't do much good

My vision of idealized reporting - just like Google maps

Got someone nasty in your practice? Your best option is not to feed the troll.

There are more than a few clinicians out there who decide they want things done the way they want them, and that’s that.

At least one radiologist is tired of ED physicians asking 20 questions after every scan. Do you share his pain?

I recently heard some news about a colleague from my residency. He’s doing quite well for himself, holding a full-time job and also covering extra hours on the side. I know more than a few full-time radiologists whose annual salaries are less than half of what he’s earning, so it was a surprise to learn that he’s feeling frustrated. His dissatisfaction is not due to his long hours; his central issue is that his annual take is below the million-dollar mark.

. Reimbursements continue to diminish, while the costs of doing business steadily increase. Meanwhile, we don’t seem to have lost any of our middlemen. In fact, the offered solutions usually seem to involve the creation of even more middlemen, who we are told will increase our efficiency and help us streamline our operation. Middlemen who will hold clipboards, sit in meetings, and spew words like “quality” and “compliance” when they have to show what they’ve contributed to the system.

Your least-favorite tech makes a rookie blunder and screws up a study, perhaps, or PACS fails just as you are hit by a quartet of STATs. What do you do with your aggravation?

Once upon a time, when I worked primarily in hospitals, “stat” referred to emergencies, or at least something with real urgency (such as the patient is being cleared to have surgery tomorrow morning, etc.). After leaving the inpatient (and ER) world for outpatient imaging centers, I encountered some other uses of “stat.”

In our insulated world of diagnostic imaging, we might not have expected "noctors" to impact us all that much. However, I’ve noticed a trend in the past year or two for an increasing number of off-the-wall imaging studies to come my way... and most of this uptick seems to be from non-physicians ordering the studies.

Especially in the current economic climate, it might not be possible to keep up with the Joneses, dollar for dollar. Under such circumstances, it’s always worthwhile to consider what intangibles you’re offering your troops, before they ever consider breaking ranks.

Yes, times are tough. Costs are up, reimbursements are down, yada yada yada. And it’s true, you might not need the flashiest equipment on the market, and the biggest price-tag does not always mean the best product. You might not need the Lamborghini when a Hyundai will get you where you need to go. But paying even less and getting a used junker which will break down once a week is going a little too far with the concept.