On Cherry-Picking the Easy Radiology Reads, Part 2

December 31, 2011

So you’ve had enough of seeing your colleagues traipsing through the workload, selecting easy reads while leaving the tougher stuff for you, and you’ve decided to study their tricks - either to counter them, or fight fire with fire. I’m here to help.

So you’ve had enough of seeing your colleagues traipsing through the workload, selecting easy reads while leaving the tougher stuff for you, and you’ve decided to study their tricks - either to counter them, or fight fire with fire. I’m here to help.

As originally advised by Sun Tzu, the successful warrior knows his battlefield. Tactics for cherry-picking depend on how the workflow is handled in your environment. If you’re in a highly efficient, top-of-the-line paperless department where cases are assigned in order of priority and subspecialty, it’s going to be tougher - those computer geeks know what you’re trying to do, and have been paid well to prevent it.

Fortunately, with the disorganized, underfunded mess that healthcare has become, nobody can afford the really good systems, and most departments function in variable states of chaos, which leave plenty of weak spots to exploit.

If you’re lucky, you work in a place that still relies on such archaic mechanisms as paper charts and film-folders. In this case, browsing for easy reads (or ditching ugly messes) is easy; a case is yours only as long as you physically hold the file. You can pick up a stack of cases (be sure to visibly tote the pile back to your desk so everybody can see how busy and industrious you are), select and read the ones you like, and quietly replace the others later on.

Avoid the really thick files. Lots of old films and reports usually imply that you’re dealing with comparison-studies and/or a complex medical history. That almost always means more work, which you want to avoid. Besides, they’re heavy, and thus no fun to lug around.

Don’t be skittish about taking more cases than you know you can read. Remember, you won’t be keeping them all. If you don’t leave anything behind for others to read, that’s no problem - sooner or later, well-meaning members of the team will approach you (either directly or via office staff) to see if you have anything that can prevent them from sitting idle and looking unproductive. You can then generously hand over one or more of the uglier cases you inadvertently grabbed.

When you’re done with the cases you’re willing to read and have nothing but time-consuming messes left, it’s time to return them to wherever unread cases are kept in your department. This is the dicey bit, as you don’t want to get caught red-handed replacing them in the stack. Get familiar with the flow of human traffic in the area, so you can identify a good time to sneak those files back when nobody’s looking. If someone is stubbornly hanging around (like a CT tech at the nearby console), simple ploys like pointing behind them and asking about something on their monitor, desktop, or wall might be all it takes to get their eyes away from you long enough for you to deposit your cargo, maybe swapping it for another load of easy cases.

If such sleight-of-hand won’t relieve you of your unwanted work, you might need to get more overt about it. Bring cases back to the tech, saying they need time-consuming post-processing like complex 3-D recons. Give charts to the file room folks because older films need to be pulled for comparison/correlation. Don’t commit the rookie blunder of hanging on to the file while they do their legwork, since they’ll just eventually return to you when their tasks are completed; leave the charts with them.

If they do remember their tasks were on your behalf and seek you out, well, now you’re on your last legs, in more or less the same boat as if you were in a high-efficiency paperless department with software built to foil your nefarious plans. At this point, you’ve got to take some blame for ditching these albatross cases. Use these ploys sparingly, lest folks catch on. You’ve got an appointment, and can’t take any more cases to read right now. You just got word that two to three cases already in your possession have been made super-STAT, and you’ll read the ugly case after them if you still have time. Dr. So-And-So read the prior study on a nightmare MRI, and it’ll be more efficient if he does his own follow-up read. Maybe you’re getting your very first migraine (at the tender young age of 46), and need to call it quits for the day.

Then again, perhaps you could simply be better than the cherry-pickers, and read the damned case. Just a thought.