A Radiology Wish List for Santa Rad

Relief from looming reimbursement cuts, a PACS system that allows customized keyboard shortcuts and consistently relevant clinical histories are a few of the items on the wish list for this radiologist.

I didn't grow up celebrating Christmas. At no point did I believe in an entity called Santa Claus.

At an early age, I was advised that most of the kids around me did. I don't remember the exact conversion, but afterwards I couldn't understand why anyone would think some made-up character would bring them things they wanted if they were good enough. This is to say nothing of the exercise of sending letters to the North Pole, or leaving out cookies the night of December 24.

There are a bunch of reasons why the societal pretense continues, most of which are not worth getting into here. However, one of the reasons stands out to me. People like to believe that, sometimes, they will be rewarded for behaving decently (or punished for being bad). Our fellow mortals can't be counted on to make such justice happen.

We have some mechanisms to help. Money and other things of value can be traded for other goods and services. There are societal laws and contracts that can rein in behaviors and enforce agreements. However, there are plenty of ways for things to slip between the cracks. You probably don't have to try very hard to think of a bunch of injustices, whether it is good people going unrewarded or even suffering for doing the right things, villains thriving, etc.

One perennial for rads is the threat of reimbursement cuts. You probably know the dance by now. A few months into the year, a federal rule proposes to slash our income. Alarms are sounded and gripes are aired. Congress gets petitioned for a stay of execution and sometimes minor miracles occur. While the non-medical world gets raises for good behavior or simply to keep pace with the cost of living, even the "win" of standing pat is effectively a cut for us.

It would make sense if health-care workers had been naughty. Behave badly and you get coal in your stocking. I haven't heard much condemnation of docs though. I do remember that just a couple of years ago, at the height of a pandemic, health-care workers were lauded as heroes. Folks opened their windows and applauded each night.

Long-term readers of this blog might remember that I suggested at the time that real gratitude could be expressed by removing the financial Sword of Damocles from over our heads, once and for all. Of course, that did not happen and here we are. It says something about just how beaten down we have become that writeups abut rad reimbursement cuts in the past few days are acting like it is good news: We're only looking at two to three percent cuts this year. It was supposed to be worse.

Although our professional societies (and some energetic individual rads) still reach out to DC to beg and plead for better, one gets a certain sense of futility. Either the cuts will happen, or they won't. Asking other fallible humans with their own axes to grind to treat us well because, well, we've been good just doesn't seem likely to move the needle much.

During implementation of a new PAC/RIS system at one point, I noted a few aspects of the interface that were substandard. I asked an IT guy if they could be adjusted. Nope. I asked if a list was being made of things that the rads would like to see altered or improved down the line. Nope.

Even if such a list would never get acted upon, if the IT guy had taken the ball and run with it (or been advised to by a superior), and acted like the rads' concerns were being noted for future attention, it couldn't help but be good for morale. A wish list doesn't have to be addressed to the North Pole for the wishers to feel like someone might just care about them.

One might as well believe in Santa. Counting on politicians or workplace superiors to grant requests is a constant, unpleasant reminder of one's powerlessness. They can turn you down with impunity, and even if they do throw you a bone, it is a reminder that they can take it (and more) away whenever they please.

But if you can hang onto the notion that Santa (or some other divine providence) will give you what you deserve, that would be much more satisfying! You got X because you deserved it. You didn't get Y because you should've been better or maybe you were good enough, but didn't really need whatever you sought.

Further, if you're able to accept the notion of a magically wise and fair entity who's going to dole out justice, you don't really have to abide by realistic expectations anymore. Maybe a rad's best hope from DC is not to get a yearly pay cut but who's to say that Santa rad's magic couldn't possibly bring us a raise for a change? How about meaningful tort reform?

While we're talking about impossible wishes, I put a few others in my letter to Santa rad.

* A voice-recognition system that works at least as well as the free ones that come with cell phones.

* A PACS system that lets me set up my mouse buttons and keyboard shortcuts exactly the way I want them.

* Referrers who understand the importance of providing a relevant clinical history or administrators willing to force them to do so.

* Patients who follow instructions or speak up if there's a reason they might not do so, before they are on the scanning table.

* Rads understanding that their personal beliefs and expectations about our field don't necessarily hold any greater value than those of their colleagues, and at least respect differing views if they can't consider them with an open mind.

(Editor’s note: For related articles, see “What They Didn’t Tell You About Voice Recignition Software” and “Clinical Histories in Radiology: Could They Get Worse?”)