On Cherry-Picking the Easy Radiology Reads, Part 1

December 22, 2011
Eric Postal, MD

As long as the Powers That Be continue to rule that all cases are created equal, and that a normal CT which gets read in three minutes is to be reimbursed identically with a train-wreck CT that takes half an hour and bears a boatload more liability, this will continue to happen.

It’s been a good day. You’re chugging along, slightly ahead of schedule, and will be able to leave work on time or even slightly early (and if such aren’t your metrics, you’re on track to exceed your daily productivity quota and perhaps generate some bonus dollars).

You put up what should be one of your last few studies. Ugh, what a mess.

Not a single thing looks to be normal. Nothing’s rip-roaring, get-on-the-phone-immediately bad, but you’re not going to be dictating the word “unremarkable” during this report. Everything’s either postsurgical, an anatomic variant that needs commenting, and/or contains lesions.

This is one of those studies which will need numerous measurements and considerable research - and even then, you can tell you won’t be able to offer a definitive diagnosis. It’ll take several times longer to interpret than anything else you’ve done today. Proceed to read it, and you can forget all about the happy thoughts mentioned in the first paragraph.

Now, I know that you, dear reader, and I, along with most of our esteemed colleagues, would do the honorable thing here: Grit teeth, hunker down, and muscle on through. But we’ve all encountered folks who would, shall we say, exercise the better part of valor. Such maneuvers bear colorful metaphors for nicknames: Dumping (when leaving an ugly case in someone else’s workload), cherry-picking (when sifting through cases for easy, quick reads), etc.

As long as the Powers That Be continue to rule that all cases are created equal, and that a normal CT which gets read in three minutes is to be reimbursed identically with a train-wreck CT that takes half an hour and bears a boatload more liability, this will continue to happen.

One does have to admire the cleverness of the cherry-pickers. Unlike the reams of radiological and medical knowledge that we have all systematically been taught, they have had little or no tutelage in how to avoid the tough cases; they generally learned these tricks all on their own.

I daresay not a single radiology residency (or conference, for those out of training) offers a lecture, let alone a series, on these particular skills. Such instruction is even more forsaken than those elusive talks purportedly given on Business Aspects of Radiology, for instance, or How to Survive in Private Practice. Negotiating Your Contract and What to Look for in a Partnership are other such rare birds.

For those who have always wished they could answer their teammates’ cherry-picking in kind, then, I offer my view of some of the more successful (or at least innovative) methods I have seen. To spoilsports who would accuse me of pouring gasoline on the fire by doing so, let me suggest that awareness of some of these ploys might assist in counteracting them. And if that doesn’t satisfy, well, ya can’t please everybody.

Part 2 of On Cherry-picking will be in a forthcoming blog.