Calling Things Normal Without Looking

January 23, 2018

Look more closely.

Back in residency, one of the attending rads in my department had an occasional quip for trainees who offered a diagnosis of “normal” a little too readily. Invariably at the CT alternator (yes! Films! We used films in those days of yore), he’d respond, “Did you look?”

He was not, I hope, so cynical as to believe that some residents might not have properly reviewed the images before claiming to have done so. I like to think he meant a more intellectually engaged form of looking. Yes, “looking” can simply mean directing one’s open eyes at something so that a visual stimulus courses along one’s optic tracts. But then there’s looking, wherein you actually think about what you’re seeing, and perhaps draw a conclusion or two from it.

It’s dangerously easy to look without looking in our line of work. Throw a couple hundred cases at a rad in a typical day, pepper it with a constantly ringing phone and a steady stream of visitors to the reading room, and it’s rather miraculous that we remain focused on our tasks as much as we do.

Then, there are the imaging studies that pose an extra challenge to our looking rather than looking. The ones with a clinical history (or particular referrer) that screams out “This is going to be a normal study.” Or those that are so technically limited that we might feel dishonest for even offering a diagnostic opinion about them.

Needless to say, reading anything out without giving it a proper look is just begging for trouble-for yourself if not for the patient. Probably a good thing to have a keeping-yourself-honest mechanism or two to avoid this. One habit of mine, upon completing a read, is going back and staring at the clinical history one more time (see, referrers? This stuff’s important!), and then scrutinizing whatever aspects of the imaging could conceivably be relevant, above and beyond my usual search pattern.

There’s more than a little bit of looking, in lieu of looking, outside of actual image interpretation in our field, and indeed outside of radiology as a whole. You’ve probably encountered it entirely more than you’d wish to.

For instance, bringing some technical issue to the attention of Support for them to be aware of and/or fix…and their first priority seems to be telling you that, no, there isn’t a problem. Or, if there is, it’s probably something you did wrong, not their soft- or hardware. This reply often comes as they give a cursory eyeballing to your machine, or tell you to unplug and replug everything and then “let us know if it happens again.”

Or alerting the leadership in your group to something that you, as a professional trying to do the best job you can, feel could use some adjustment. Some aspect of policy, workflow, asset allocation, etc. Maybe productivity or accuracy would improve. Maybe just morale. And maybe, when you’re told they’ll look into it (but you can tell they won’t be looking into it), they’ve got valid reasons for prioritizing other initiatives more…but that’s a matter for another column. Or perhaps one that’s already been written; I’ve done a few hundred of these already, so forgive me if I lose track.

It even occurs at a higher level, for instance pertaining to my recent column on “fake partnerships” which prompted a response from another doc in our field. His upshot: Fake partnerships are an “anecdotal experience,” “not consonant with what’s actually happening.”

Now, of course, one can imagine that I made the whole thing up just to have fodder for my weekly column. Or that I’ve had a most unusual experience that most radiologists never will. For that to be true, however, all of the rads who claim to have had the same experience I described would also have to be either lying or additional examples of most-unusual experience. Maybe, just maybe, we’re worth taking a little more seriously than that.

I would therefore ask anyone who claims to know what’s going on out there in the job market: Did you look? (Try shining a “bright light” on recent partnership opportunities within radiology groups in my neck of the woods-Long Island, NY.)