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Are You Prone to Superstitions in Radiology?


Whether it’s the proverbial “bad penny” case that crashes PACS or the perception that positive computed tomography angiography (CTA) exams for pulmonary arterial clots come in sets of three, suspicions can emerge here and there in radiology.

Superstitions are silly things, sometimes laughably so when held by people other than ourselves. It is easy to attribute them to low intelligence until you notice they affect smart people too. If you happen to recognize them in yourself or folks you respect, you might forgive by thinking they are not serious beliefs, just a bit of fun, etc.

We have more than a couple superstitions in radiology. Once those notions get a foot in the mental door, they can be hard to chase away. I have nicknamed one of my work-related fixations “the bad penny.” You can easily find the expression (“a bad penny always turns up”) online if it’s unfamiliar.

Here is the scenario: I will be muddling through a typical day’s worklist when a troublesome case turns up. As is, it can’t be read. It needs the tech to send images that didn’t show up the first time, upload priors, get additional details about the patient, whatever. Maybe there are IT issues. Perhaps there is something about the case that makes PACS crash every time it tries to load. Someone needs to fix the situation, and I can’t do it myself.

During my brief flirtation with the case, I see enough to know it’s not going to be fun to read, even after everything is fixed. It is one of these nightmare non-contrast scans with plenty of artifact, complex findings, priors that aren’t going to permit reliable comparison, etc. There are any number of factors which might make me prefer not to ultimately wind up with the case. Since I only looked long enough to know I can’t read it, there is no reason that I should “own” the mess.

Indeed, I wouldn’t be at all disappointed if this hot potato wound up in someone else’s hands when all is said and done. Maybe things will get fixed after I am off shift, or when I am neck deep in other work like a trauma pan scan, and someone else will naturally pick it up. Alternately, maybe another rad will grab it and not experience my issues. Perhaps his or her workstation loads the case without a hitch, or the rad decides to read it without the multiplanar reformations (MPRs) or priors I wanted.

That never seems to happen. Like the proverbial bad penny, these cases always seem to come back. Maybe the needed fixes didn’t happen until the next morning. Not only is the case waiting for me when I log in, but it has been flagged as super STAT on account of the delay in interpretation. Perhaps one of the techs or other support staff helpfully flagged the case as being “for Dr. Postal.” Usually, there is no reason as is typical of superstitions. It just happens that way.

There’s a little bit of a sting when these things come home to roost. I lived in brief but futile hope that I would avoid a little bit of unpleasantness in my day, and now it’s like I have to pay an overdue bill. It has happened often enough that I can sometimes recognize bad penny cases when they first show up, and while it’s not quite my personal sword of Damocles, it is an annoying shoe I am expecting to drop.

If you’re reading this and thinking, “What a superstitious crackpot,” I will reiterate that you probably haven’t thought long enough about the superstitions you or your respected colleagues, even mentors, have probably held. Here are some examples to prod your memory:

Emergency rooms are probably best known for this, but have you ever been working a shift where not a lot is going on, and someone mentions that the day is “quiet?” What happens then? Of course, everybody in the area semi-frantically admonishes them that speaking the Q word will bring mayhem. “Oh, now you’ve done it!” It’s the health-care equivalent of telling an actor “Good luck” instead of “break a leg.”

Then there is the perception that cases come in clusters. In residency, for instance, surgeons talked about how inflamed appendices came in threes. If you saw two scans of appendicitis, it was a virtual certainty that there would be a third. It got to the point that you would do well to worry that you had missed one if you didn’t diagnose another.

Pulmonary arterial clots seem to like company too. I don’t know if anybody claims that positive computed tomography angiography (CTA) exams come in groups of three, but it does seem a little weird that, amongst the dozens of negative scans that turn up in a typical day, the positive ones often seem to show up back-to-back.

Sometimes, the line blurs between superstitious belief and comedy. I would like to think that vanishingly few physicians believe the Throckmorton sign is anything more than a throwaway joke, but there have been a couple of famous statements about underestimating people’s intellectual capacity.

Some superstitions have adaptive value, making them that much harder to shake. In my fellowship hospital, the rads had a rule of the house: If you talked about someone—especially unfavorably—there was a decent chance the person would come right around the corner as you did so. Taking this sometimes amusing phenomenon to heart helped you avoid thorny social confrontations.

I was particularly satisfied with one I came up with, even before residency. During internship, I learned that it was courting disaster to hang around for even a little bit after one’s shift ended. Whether it was lingering to chat or making a quick phone call at the nursing station before hitting the road, every second you were there ramped up the chance that somebody would see you and say “Oh, Doctor! While you’re still here … .

There was no graceful way to say “No, find someone else,” even though the folks on shift after you were around somewhere. Instead, to be the good guy, you were now on the hook to do X. While you were doing that, they had plenty of time to come up with Y, Z, and cycle back to the beginning of the alphabet for you.

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