Eric Postal, MD

A cruel drama is played out every September across the country: Children, already distraught at the end of summer vacation and the resumption of school, are handed their first bundle of homework assignments. And commonly, their beloved summer recess is used against them in the form of a “What I did [or learned] during my summer vacation” essay.

Dear Old-timer, It’s me, the new guy you recently hired for your well-established practice. Even though it’s been a few weeks since you agreed to bring me on board, I imagine you remain uncertain - you must have unspoken concerns about whether I’ll fit in as a good member of your team.

Way back when, during my first year of radiology residency, I noticed a peculiar trend in the department.Well-educated folks, born and raised in the USA with English as their primary language and no trace of a foreign accent, were speaking oddly - but only in the context of metric measurements. Very specifically, the unit which referred to a hundredth of a meter: They called it a “son-timeter.”

I wish I could openly say some of these things to you, but I hope that you already know them on some level. I am both excited and nervous to have you join my practice. On the one hand, I’m hoping this will be a harmonious and mutually beneficial relationship that lasts a long time. On the other, I know how things can go awry, and plan to be very attentive to signs of developing trouble.

Tired of being everybody's answer-man or go-to gal? Somewhere, there are radiologists who prefer to sit quietly at their workstations, cranking out cases to the best of their ability and cringing every time their flow of productivity is disrupted. I'm here to help.

Necessity is the mother of invention, after all. It would only take one or two radiological entrepreneurs to figure out a successful business model for opting out of participation with third parties; others, seeing that it could be done, would likely follow suit. In a way, being pushed to our limit could force us to reclaim control of our profession.

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.