A Canary in the Radiological Coal Mine

There is a peculiarity about careers in medicine, especially specialties with longer postgraduate training regimens like radiology. After half a decade of learning by doing — working your trade while heavily supervised — you can emerge with no concept of your identity as a professional.

Up to that point, you have mostly just been a reflection of your mentors. You do either what they directly tell you to, or what you know they will expect when they arrive to review work you did in their absence.

Afterward, you are on your own and you might only find out what that means as you go along. Are you going to be industrious and productive, or more relaxed, even lazy, by some estimations?

For instance, I had no idea what a good day’s work was in the world of outpatient imaging centers. How could I know how many cases I should be reading? My only frames of reference were single subspecialty rotations I had done in residency/fellowship and the hospital mix I had seen “on call.” All I had was a vague notion that I should pretty much always be working at something, and that I would get faster as I moved along (getting comfortable, learning efficiencies, etc).

That sufficed as it turned out. Just by doing that, I was soon producing more than most of the folks around me without making a bunch of diagnostic errors to indicate I had better slow down. I was not superhuman. When I moved into the per-click world, there were folks lots speedier than me. But I could put my nose to the grindstone and “get ‘er done” as Larry would say.

It completely flew under my radar, for years, that this made me a perfect canary in the radiological coal mine.

By that, I mean that I always seemed to be the rad discovering technological or logistical issues. I would be plugging along and notice that software X or gizmo Y wasn’t doing what it was supposed to do. I might puzzle at it a bit, trying to fix things myself, but sooner or later I would be reaching out to Support, or whatever substituted for it in my job at the time.

I would start by asking if whatever I was dealing with was a “known issue,” since that would mean I shouldn’t hope for a fix anytime soon and just work around it. It almost never was, so we would move on with trying to define what was wrong and hopefully correct it.

Unfortunately, when you are the first one to come up with something like that, Support’s usual reaction is to assume the problem is you or something at your end. It’s also easiest for them to make you walk through all the most common fixes (log out and in again, reboot your system, unplug and re-plug everything), before they move on to doing anything themselves.

At some point, unless you are the only one working, other rads step forward with the same issue. Now Support seems to take things a little more seriously and stop treating you like this is your first day with a workstation. It is very easy to develop a bit of resentment. Oh, you believe them when they tell you that something systemic is wrong, but when it was just me, you had me playing with my plugs and power switches.

If you were one of those rads, rather than the canary in the coal mine who first fell victim to whatever is malfunctioning, you wouldn’t have had the time-wasting experience of being Patient Zero. You would just reach out to Support, hear that you were not the only one with a problem, and await the fix. Alternatively, you wouldn’t even have to do that. They would make an announcement and maybe even fix the thing before you noticed it.

The more productive you are or the more attentive you are to the world around you, the likelier it is that you will be the canary. It is just statistically more likely that, as someone who is using the system with greater frequency —opening, manipulating, and signing off cases — you will be the first to trigger (and notice) errors.

Once you realize this, if your experience resembles mine, it is like emerging from life in a bubble. (Remember when I wrote about that a few weeks ago?) I was suddenly able to look back and see that, before realizing I was a problem-detecting canary, I wrongly blamed my experience on other things and came to some maladaptive conclusions.

If I could go back in time and talk to my younger self — or any young rad destined to become a higher-percentile producer — I would forewarn of this phenomenon. Hey, buddy, you might not know it yet, but you are going to be the tip of the spear in identifying a lot of problems. If you can embrace that, you will save yourself a lot of heartache down the road.

For instance, don’t think poorly of the Support people. You will be telling them a lot of things they are hearing for the first time. They will need to gather info on the situation before they have any hope of telling you something more than you already know (reboot, etc). Don’t expect them to remember that you are the rad who is savvy enough to already have tried things like powering off and on before reaching out to them. They probably deal with hundreds of users every day.

Try not to think poorly of the other rads around you either. It will be easy to think of them as not noticing or caring that the software isn’t working the way it should, the techs aren’t adhering to protocols, etc. Like it or not, you may be just noticing these things sooner because you are seeing them more frequently.

Also, be charitable with yourself. If you keep hearing things like “You are the only person who has complained about this,” you might start wondering if you are being a prima donna or at least coming across that way to other folks. Don’t gaslight yourself. If things should be working a certain way and they are not — especially if they previously did function properly — it is not your fault for noticing them and doing your part to get them back on track.