Does concern over productivity and RVUs prevent you from taking the time to address weaknesses and workflow inefficiencies?
During the first half of medical school, I wound up with a handful of paperbacks about the firsthand experiences of med students and house staff. Some were true to life whereas others were more fictional in nature. I don’t know if I considered these books serious prep for my imminent future, but it couldn’t hurt. House of God was one popular example.
However, I think it was in Michael Crichton’s book, Travels, where I first encountered the tennis expression “Running around your backhand.” If you’ve played tennis or even similar stuff like ping-pong, you’ve experienced this. Your forehand tends to be better than your backhand. An opponent might do better against you by intentionally sending the ball to your “bad” side, or sometimes the ball just happens to go there.
Faced with that situation, you have a choice. You could use the backhand. Even if it goes poorly, you’re incrementally improving, and eventually it will not be an issue. Alternatively, when you see the ball isn’t coming to your forehand, scramble to get on the other side of it. You literally “run around” your less reliable backhand so you won’t have to use it.
Outside of the situation, the choice seems obvious. You should do the work and develop your backhand since it will make you better in the long run. However, when you’re in the middle of a game, the second choice can be tempting. Using your backhand, right now, will probably cost you points. Why risk the game, not to mention embarrassment, as your opponent watches you goofily backhand the ball over into the next tennis court?
So maybe you never decide to work on it while playing. You promise yourself you will get it to it later. Maybe you imagine you will set aside some time outside of an actual game to practice. Add that to the stack of other things you say you’ll do “sometime” and see if it ever happens. Meanwhile, the deficiency of your backhand skill never gets better and, sometimes, you just can’t run fast enough to avoid having to use it.
Let’s put this another way. You can pay now (with diminished performance while you fix your situation), or you can pay later (with chronically suboptimal performance because you never actually addressed the issue).
“Running around your backhand” has seen enough use that it’s become an expression for any instance of avoiding weaknesses in the name of better performance at the risk of never fixing those weaknesses. It has come to my mind more than a few times, during my daily grind at the radiology workstation, especially when starting a new job.
There is a variety of examples. I encounter something that reasonably should work better. Voice recognition doesn’t transcribe me properly. PACS doesn’t faithfully follow my hanging protocol. Prior studies don’t get identified, uploaded, and/or displayed properly. I should be able to read a certain type of study or exams from a certain facility, but the software won’t let me because it says I don’t have the “permissions” for it.
I could go on and on because I can’t remember the last time I had a flawlessly smooth day in any job let alone life itself. Everything from minor speed bumps to axle-breaking potholes is strewn across the metaphorical highway of my daily grind. Whether it’s getting up to speed on new software, adapting to adjustments in workflow or learning new systems as part of a new job, there will always be challenges.
Whatever the issue is, I can try to fix it, whether it involves retraining the voice recognition software, or messing with the software’s features so some of its persistent errors stop happening. I could also reach out to IT or various other support people regarding the various bugs and glitches bedeviling me. I could inquire with folks in leadership about inefficiencies in protocols that might be improved, potentially for other rads as well as myself.
All of these things, however, would take time away from my reading cases and otherwise doing what is expected of me. While I am trying to get a hold of other folks, explain my situation and let them remote-in to my workstation to watch me demonstrate my issues (if, indeed, they can reliably be reproduced for an audience), I am not generating RVUs.
Maybe my job depends on those RVUs to determine whether I’m meeting expectations, or my tally will impact what I see in paychecks/bonuses. Also, being new at my job, I may want to make a good impression and show that my employer was smart to hire me. This is a key consideration, especially if I have got multiple suboptimal conditions that I’d like to see fixed. Addressing all of them, right now, might decimate my daily numbers. Plus, the last thing I want is to appear needy/demanding to the powers that be by constantly asking them for things.
Accordingly, the pressure is high for me to “run around my backhand,” and find ways to live with all the stuff that I think could/should be better. Just for now, I might tell myself. Let me adjust to everything and I can address these matters down the road.
Instead, as time goes by, I acclimate. I find workarounds for the various issues to the point that I perform well enough to satisfy myself and/or whoever is watching me. Fixing those issues would still improve my situation but I have diminishing interest in expending time/effort on them. After all, taking them on would still mean that I’m going to hit the worklist a little less vigorously today, which remains a disincentive to me.
Also, I might now have less political capital to get the assistance of others. Well-ensconced in my job, I’ve surely asked them for other things or plan to do so. The honeymoon-period from my new hire days has long since expired, and it may be a heavier lift to get anybody to do things for me.
It is unfortunate because the “pay later” aspect of running around my backhand stands to be a drag for my job and likely the work of others. If I am performing at, say, 90 percent efficiency, chances are excellent that other rads are also struggling with this. That is a lot of productivity left on the table.
A proactive rad group would make a point of tapping into this, perhaps by carving out dedicated non-reading time for troubleshooting and optimization. Quarterly or even monthly brainstorming sessions looking into these issues could be beneficial. Perhaps there could even be a handy “I’ve got an issue” button somewhere on the workstation. You would click it and record a brief description of whatever is impeding you. The audio file flies off to a team troubleshooter’s inbox, and you get back to reading your case in a matter of seconds.