Backstabbers in Radiology: Alternatives to a Kevlar Vest

A little while ago, a rad posted on social media about a “malpractice mole” in a rad group. It’s not worth going into the details, but the upshot is that some individual with access to health-care records was funneling prospective cases to a local med mal legal firm.

For instance, the mole might see a CT from last month that identified a cancer. He would go digging into prior imaging studies on that patient, looking for anything that might arguably have shown the pathology previously. He would then get a kickback from the ambulance chasers for tattling that radiologist X, who had read an MR on the patient five years ago and failed to call a ditzel the potential cancer, could be targeted.

Maybe this is really happening (or, if you have a sufficiently low estimation of humanity, you might wonder how it couldn’t already be going on). Maybe it’s just playing to our worst paranoid nightmares.

What doesn’t seem questionable is whether there are individuals out there who would be sleazy enough to backstab colleagues (along with violating HIPAA and other bad behavior). Unless you have been incredibly fortunate or naive bordering on Pollyannish, you have probably seen folks who would do this sort of thing if they had the opportunity. One might wishfully imagine physicians to be above such things, but one would be asking for disappointment.

I can’t say I have seen radiological backstabbing at quite that level of villainy. Shoving someone into the crosshairs of the malpractice system, even if it’s a garbage case that gets tossed, imposes at the very least a permanent administrative hassle and a drag on their time and morale for months/years while the case slogs forward. Plus, there is a non-zero chance that the physician in question is found liable with all the repercussions that can bring. You’re literally threatening the person’s career.

Still, I have seen more than a few rads who seem entirely comfortable with cheating, undercutting, and otherwise victimizing their colleagues. Sometimes it’s not even for tangible gain. One of my very first blogs in this space was about rad “trolls” who just seem to enjoy fomenting strife and unhappiness in their professional environments.

Faced with the possibility that you are dealing with such miscreants, it’s probably not the best move to immediately call them out. Things aren’t always as they seem, and it’s not great for your reputation if you are constantly accusing folks who turn out to have reasonable explanations for their actions. Plus, charging into lots of unnecessary battles would be exhausting.

On the other hand, sometimes things are exactly what they appear to be. If you don’t have sufficient evidence to prove that someone in your group is a backstabber, that doesn’t make them innocent. It’s entirely possible to satisfy yourself of their guilt without having the goods (or time/trouble) for a public “J’accuse!”

When that is the case, you don’t owe anybody an explanation if you proceed to defend your own back from the individual’s blade. You might be charitable at first, thinking you will give him another chance or two but if you have already seen an unequivocal “strike one” offense from him, you have got to ask yourself if you really want to give him any more swipes at you.

The most surefire defense is to remove yourself from backstabbing range. Depending on the pattern of attempted predation, that might just mean avoiding being on the schedule together. Pulling from separate worklists could also help. Having no overlapping credentials at all would be another level of separation.

Ultimately, a complete “divorce” might be what is necessary. If, for instance, the bad egg holds rank or is otherwise entrenched in your current workplace, protecting yourself might just mean going elsewhere. That is not a quick and simple move, but it might be the best option. The “troll” I referenced in my old blog managed to drive away a big chunk of her rad group because each of them found it easier to seek greener pastures than to try forcing her out.

You might not want to bail. After all, why should you leave if you like where you are and have done nothing wrong? You might choose to stick around, even knowing that you will have to keep your guard up.

It can be a step towards escalation — even dipping a toe into the troll pool yourself — but under such circumstances you might do well to establish some quiet alliances with others who have become aware of the backstabber’s misdeeds. You can keep each other informed or, at the very least, mutually shore up morale that, despite the thorn in your collective sides, you have got a core group that more than counterbalances what the nogoodnik brings to the table.

If push ever comes to shove, for instance, if the backstabbing rises to the level of the malpractice mole, your group might approach the leadership. Sorry, sir, but this situation is untenable. You’re going to have to choose between the backstabber or the group of us.

There is another benefit of this quiet solidarity approach. Even without openly declaring hostilities against the villain, if enough of you are on quiet guard, it can create a certain “cold war” vibe. The crumb will notice sooner or later and be that much less likely to attempt shenanigans against folks who are visibly wary.

I recall one individual, way back at the beginning of my rad career, who had managed to generate a bad reputation through a pattern of self-serving behavior. One by one, folks learned to stop doing favors for her or otherwise playing ball. At some point, she openly complained that she wasn’t as “evil” as everybody seemed to have decided she was.

Nobody took the bait and reassured her, or indeed said anything in response. The silence was better than any retort we could have uttered.