Augmentation

August 15, 2014
Eric Postal, MD

Sometimes a radiologist just needs to vent.

Mention “augmentation” to medical imagers, and you’re likely to inspire a different set of mental associations than in the general population. Mammo types will likely think of implants. Those dealing in ultrasound, probably maneuvers to boost vascular flow.

Those attending earlier phases of medical education, however, were introduced to another type of augmentation, in the setting of testing reflexes. If a patient did not seem to be showing a response, one could instruct the examinee to tense up other musculature, such as with the Jendrassik maneuver: grasp each hand with the other, and try to pull them apart. With this background of tension, other muscular activity, such as the reflex being tested, was neurologically augmented.

I’ve subsequently noticed another type of augmentation; a psychological one, and not specific to patients. Rather, it seems prevalent in those of us providing the actual healthcare (though it’s not unique to medicine). The basic mechanism is the same: amplify the background of overall tension, and specific areas of stress stand out more visibly. Sort of like turning up the gain, whether it be on your stereo-system or your ultrasound machine.

Take, for instance, an interruption in your workflow. Let it be something reasonable (like having to determine whether a patient with imperfect renal function should get contrast), or not so much (a referring clinician wants you to dictate an addendum regarding something you already clearly addressed in the original report). If this interruption comes when you’re all caught up with your work, maybe even a little bored, during your after-lunch somnolence…no biggie. You might even regard it as a welcome mental stimulus.

Now let’s say it’s exactly the same time of day, but you have a stack of about 10 cases to get through, and the day has already been pretty busy thus far. You might not be so phlegmatic. How about if we move the hypothetical clock forward to late afternoon, and add the notion that you won’t be free to go home until those 10 cases get done? You might have trouble responding to the interruption without an evil look on your face or an ugly tone in your voice. Throw in a few other stressors, not even work-related (stocks performing poorly, Mercury in retrograde, whatever), and you might get downright ornery.[[{"type":"media","view_mode":"media_crop","fid":"27070","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_7548384457029","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2598","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 250px; width: 250px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

In other walks of life, it might be feasible to recognize that you’re getting pretty tightly-wound, and take a sanity-break. Leave your workstation, go for a stroll...anything that gets you away from the steady tide of incoming stressors. A la Vincent from Pulp Fiction, you’ve recognized that you’re a race car in the red, and you’d rather avoid the fallout that you know will come your way if you blow. Even this is taking something for granted; like the proverbial frog in gradually-heated water, you might not recognize how stress-augmented you’ve gotten until you find yourself snapping at somebody.

Folks in other specialties of medicine might not understand our inability to step away from the strife for a little cooling down. Clinics, ERs, and inpatient wards tend to have staffing redundancy, such that, if a doc is busy with other things, there are others to pick up his slack. Especially with endless rounds of financial cuts and a general “do more with less” environment, a radiologist is often single-handedly covering one or more entire facilities, or at least his subspecialty’s share of cases…there is nobody else to man the fort, and if the covering rad decides to take a powder, it’s tantamount to going AWOL.

So what are the other options? Become an imperturbable Zen master overnight? Forgive yourself in advance for occasionally mouthing off at whoever happens to cross your path at the wrong moment (and be ready to face disciplinary action afterwards for being “disruptive”)? Vent your aggravation in your reports with semi-sarcastic comments?

I’ve found myself trying to channel the stress-energy, in the heat of the moment, to positive ends. Namely, reducing or eliminating the stressors which seem most counterproductive to my job as a radiologist. Some efforts have included sending feedback regarding less-than-perfect aspects of voice-recognition software, or PACS. Sometimes the feedback is directed towards usage of more appropriate imaging protocols, provision of better clinical histories, etc.

It’s rare that any of these communications are totally new. Rather, the things that really light a fire in my belly are problems I have previously tried to address multiple times, and part of my aggravation comes from knowing that I have gotten few or no responses to my previous umpteen inquiries…so really, do I expect results from #umpteen+1? Still, it costs less than venting frustrations on office equipment, and doesn’t hurt quite as much as banging one’s head against the wall.