A Portrait of Two Radiologists: Jealous and Generous

I have had occasion to write a couple of blogs contrasting different stripes of radiologists. Today, I’m keeping it simpler, focusing on two poles of a spectrum. Hopefully, if you identify yourself with one or the other, you find it flattering or at least a resource for self-improvement.

The spectrum ranges from “generous” at one end to “jealous” at the other. Who is a generous rad? There are many flavors of generosity. One can be giving of tangible things (“Go ahead, use my pen. Heck, why don’t you hang onto it? You will surely need to write stuff after you have left my reading room.”), but the intangible stuff is what prompted me to write this.

The jealous rad isn’t necessarily a Scrooge who hoards all of his or her stuff. This rad might just have the one pen and giving it away will leave him or her having to go search for another. Maybe it’s a Cross or Montblanc, and the rad is reluctant to even let someone else handle it for fear of breakage. Perhaps the rad is a germophobe and would prefer to minimize contact, especially with some clinician who has been roaming the hospital like a disease sponge on feet.

There is generosity of time, which can be a lot harder to maintain than just handing off a pen or some other material object. A lot of us constantly work with the threat of falling behind on worklists, struggling to squeeze in a much-needed break for lunch/coffee/loo. It is not always easy to handle reading room visitors or phone calls with grace, answering folks’ questions so they truly understand and have all issues addressed without feeling hurried or brushed off.

Time-jealous rads might once have been more generous but became jaded. It can feel like they keep getting the same questions over and over. These questions may often come from the same people. Are they even paying attention when we answer? A lot of these inquiries shouldn’t even be necessary. They’re asking about things the rad already stated in the report or asking the rad things beyond his or her purview. (Can this abscess be drained? I don’t do those procedures, Maybe you should ask IR.)

I wouldn’t be surprised if there is a disproportionate number of time-jealous rads in the pay-per-click world. Suppose, for instance, you are a telerad “hired gun” whose sole purpose is to clear as much of the worklist as you can. The actual employees/partners of the rad group are earning healthy salaries that are far less dependent on productivity. “Baked in” to their comp is the notion that they are doing plenty of non-RVU-tallying activity.

As the per-click hired gun, even seamlessly and efficiently consuming as many cases as you can might still clock you in below what one of the rad group’s members earns. If you weren’t contracted to do anything but read cases, you might feel a little put out (or worse) to have techs, clinicians, etc., somehow getting your phone number to interrupt your RVU workflow when they are supposed to be calling the salaried folks. To you, it’s simply the agreed upon division of labor but, from the perspective of the techs/clinicians, you are being jealous of your time.

Even less tangible (but just as real) is the generosity/jealousy of expertise. Again, this isn’t limited to radiologists at all. Pretty much any talent or skill can be involved, and despite my calling it “expertise,” one doesn’t have to be an expert. This finds its way into all levels of capability, even when people are not all that capable, but think they are.

It can be a neuro gal or a body guy. It can be a generalist rad, one of the surgeons, or a physician-extender in the ER. It can be someone with 20 years of post-training experience, or someone who is still in fellowship. It may even be tech-support folks or administrative types, anyone who has got a smidge of responsibility.

Whoever they are, if they are generous with their expertise, they will share it with you. A rad will point out how he or she arrived at the diagnostic opinion. A surgeon will explain what has been done (or is planned to occur) on the OR table, perhaps the rationale behind it and what potential complications are at hand. The NP in the ER gives a proper clinical history rather than “R/O path.” The fellow makes a point of teaching his or her residents rather than just getting the work done ASAP.

Expertise jealously takes a few forms. A common type comes across as “I earned my knowledge the hard way. Why should I spoon feed it to you?” It can be seen as early as elementary school, refusing to help classmates with their homework. At a physician level, it often has a disparaging flavor. “You shouldn’t need to ask me this. You learned it in med school/residency if you were paying attention.” “I look things up when I don’t know them. Why can’t you?”

Generosity/jealousy of time and expertise often go hand in hand. If a body rad is asked by a clinician why he or she is calling a liver lesion hepatocellular carcinoma rather than focal nodular hyperplasia, the rad has to give of his or her time and knowledge to satisfy the inquiry in such a way that the clinician “gets” it. If the rad is 20 cases behind where he or she should be, or of the mind that anybody can look up the radiology of these lesions if they want to know the difference, the rad might not be so accommodating.

Here is a word in defense of the jealous. Most of us regard generosity in a positive light, and frown on jealousy. It is a cousin, after all, to one of the seven deadly sins. (If you don’t know the difference between envy and jealousy, take a moment to learn. Otherwise, you might not understand why I used jealousy to oppose generosity.) I have made an effort to point out why, in some circumstances, what might be viewed as jealous behavior is understandable if not meritorious.

We expect certain things of rads and other potentially “jealous” individuals such as mentioned above. Go too far to the generosity end of the spectrum and you might find them unable to live up to their responsibilities. For example, suppose a rad is such a do-gooder with his or her time, helping out hither and yon, that his or her own workload is constantly neglected.

Even consider a per-click hired gun without jealousy. As the months tick by, the rad’s RVU totals and paychecks suffer. Unable/unwilling to protect his or her reading time sufficiently to earn reasonable compensation for the current job market, the rad might apologetically tender a resignation. Then the group that contracted with him winds up with neither a list cleaner nor a helper.