Another Drop in the Ocean

October 19, 2020
Eric Postal, MD

How many lives have you changed, one scan at a time?

Years before I even thought of writing my first blog, I made a series of attempts at fiction-writing. I’m pretty creative, and as a young ‘un I did more than a little reading, so I had seen plenty of examples of others’ successfully-finished products.

I never completed one myself, except for the occasional short story. I would get a great idea and dive into it, churning out page after page while I had time and a good head of steam. Then, life would get in the way, and it might be hours or days before I had another chance to sit at the keyboard…during which my mind would be moving further and further ahead of what I’d written. Eventually, the volume of ideas which awaited transmogrification into actual writing was sufficient to quench my enthusiasm.

The notion occurred to me recently: Never having gotten more than a couple-dozen pages into my would-be novels, I wondered how much blog-volume I’d written by now. Windows readily informed me that there were 459 files in my “blogs” folder. They’ve averaged around 2 pages each…Good Lord, I’ve written enough to fill three respectable volumes.

Of course, this is the result of pacing: Putting together a few hundred words once per week, rather than trying to crank out the Great American Novel before I get bored with it and would rather be doing something else. If you told me, back when I started this column in 2011, that I would be writing close to a thousand pages in the next decade, I might not have believed you. Even now, the thought is rather exhausting.

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There’s a parallel to be drawn between this and one’s body of work as a diagnostic radiologist. If an early-in-career rad is sizing up a prospective job that expresses an expectation of X number of RVUs a year, or Y number of cases per day, that might sound daunting. The young rad might not even know how many cases, let alone RVUs, he’s able to do comfortably/competently. Or how the particulars of a given workplace will help or hinder that.

Learning one’s capabilities doesn’t make this entirely vanish. Knowing in the abstract that I’m capable of X amount of work is one thing. Being told that I can expect to receive X amount is another, potentially anxiety-provoking matter: Will I continue to perform as I have? What if they give me more than X? What if what they give me turns out to be more complex than I’ve previously seen, and I can only do 80 percent of X? Will they expect me to ramp up and do more than X in the future? How can I increase my capacity?

I’ve probably mentioned at some point that my first job after fellowship was in an outpatient practice that routinely maintained a backlog of cases. You’d walk into whatever reading-room you were assigned for the day, and there would be shelves and stacks of folders waiting for you. Almost every day I was there began with a withering sense of “How on Earth am I going to get through all of this?”

Each case can feel like a drop in the ocean, especially if you’re sizing up everything you’ve got ahead of you all at once. Heck, even in hindsight: there have been times I look back on a busy workday, or some other task, and thought, “How on Earth did I do all of that?”

One way to get through it is to avoid focusing on the individual drops. Back when I ran on my school’s “track and field” and “cross-country” teams, I found out for myself that it was an awful lot easier to run my miles when they weren’t divvied up into countable things like laps. One “away” meet was at a school with an eighth-mile track instead of the usual quarter; having to do twice as many circles, even though it was the same distance, was a killer. I maintain to this day, that gave them an unfair home-field advantage.

In our line of work, however, I try to resist seeing the forest instead of the trees. Each one of these cases is our contribution to someone’s life. Whether it’s checking up on the status of their cancer or screening for it. Evaluating their bone density or carotid arteries to see if anything might be done to avoid hip fractures or strokes. Finding potentially-treatable reasons for symptoms…or evidence for reassurance that nothing bad is going on.

Just as I look back on my 900-plus pages of blog-writing, a rad might think back on however many thousands of lives he’s touched each year. If you’ve been in this game for even a little while, chances are excellent there’s a decent number of people alive today who might not have been without your contribution to their care. Or enjoying better quality of life.

On top of that, there are more than a few clinicians who are now wiser as a result of having interacted with you. You might have taught one how ultrasound is better than CT in a given situation, or why it’s worthwhile to give oral contrast rather than just throw someone on the scanner in the name of “throughput.”

There are surely also other rads who have learned by reviewing cases with you, or seeing your work when it’s a prior study they’re using for comparison against a current case. Indirectly, your impact on them has benefitted the innumerable drops in their oceans, as well.

Follow Diagnostic Imaging Editorial Board Member Eric Postal, M.D. -- @EricPostal_MD

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