Always on

April 21, 2017
Eric Postal, MD

Radiology has come a long way since the days of lone on-call resident coverage.

During internship, or maybe even late med school, I occasionally found myself dwelling on the notion that certain aspects of hospitals were always “on” by virtue of a single member of staff.  Of course, ERs were 24-7-365, but that wasn’t quite the same phenomenon, since even when there’s only one actual physician running the show in the ER he has a team of other healthcare personnel and can freely summon consultants from all other specialties as their areas of expertise come into play. As a lone radiology resident on call, I knew I theoretically had the ability to ring up my attendings…but that was supposed to be an exceedingly rare circumstance, only when things were really, really ugly. Otherwise, it was more than occasionally the case that “radiology” was a single individual, representing the whole department. Not too many other services were like that. Internal medicine, surgery, peds, etc. – each had an on-call set-up wherein, at a given time, there would be at least one senior and one junior resident, as well as one or more interns. They could support one another, or at least “divide and conquer” things that needed to be done. It seemed, simultaneously, an incredibly strong thing and a tenuous one: coverage never stopped. It was an unbroken timeline, spanning God knows how many years. Yet, at numerous intervals, that line consisted of one person, and it wouldn’t take much for the line to be cut.  Yes, safety nets existed. If the solitary covering rad took ill, blew a mental gasket, or otherwise became unavailable to hold the fort, contingency-plans would pull a backup-call rad into the mix, or an attending could come in. Still, there would be a period of time before the cavalry came charging over the hill. This never happened in any facility I know of…but, surely, it must have occurred somewhere? Times changed, and I doubt current or future generations of radiologists will ever think of such things. We now have this wonderful Internet-thingy, with super-duper-high speeds of data transmission. Facilities routinely get round-the-clock attending reads on studies, final reports (not preliminaries), even expect subspecialty reads on routine cases. It’s lots easier when you have your docs able to do their job from home or even another medical facility. In just about all of the ways that matter, it’s a positive turn of events. Better patient care, more reliability, increased efficiency, etc. About the only thing I can think of that might be a loss is the sense of self-sufficiency, capability, and pride that a radiology resident experiences when realizing that, even if only for a few hours at a time, she or he is radiology in the facility…and embraces the role. I hope we’re finding ways to hang on to that.