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Coming to Grips with Desktop Hyperplasia


Is there a tipping point when the technology you need overwhelms a workstation designed for optimal efficiency?

I got my new teleradiology workstation this past week. Unpacking and setting up was simple enough. The biggest chore is always snaking wires behind the desk, so they don’t look like an eyesore. I think there’s something niftily Matrix-y about having all the stuff tumbling over the front and sides of my desk, but I was disabused of that notion not long after the lady of the house moved in.

This being my third telerad rig since 2011, I find it interesting to compare and contrast the differing setups. The biggest change this time around is that I have four monitors. I was uncertain whether everything would fit on my desk, even though it is pretty big. I called my rig “MonitorHenge” back when I was surrounded by an arc of three monolithic screens, but the nickname seems even more fitting now.

It is a far cry from my residency. I have dated myself in this column by referencing the prior use of films, lightboxes, and alternators. There was not much to put on desktops back then. There may have been a phone, pens and China markers, and some papers (such as the list of cases and imaging requisitions so we would know what we were reporting). There was no need for tape recorders. We touchtone-phoned a transcription service. Computers for proofreading and signing reports were scattered around the department, usually in corners of the reading rooms rather than right in front of where the films got hung.

The transition from films to PACS occurred while I was in training and occurred in some reading rooms faster than others. Initially, a typical desk got only one monitor plus a keyboard and mouse. There was plenty of room left for your coffee, books, and whatever else you wanted to have handy. For a while, there still had to be apparati for hanging films, lest pre-PACS prior studies existed. Therefore, the desks had to be small enough to exist side by side with the older gear.

There was a gradual but steady progression in the volume of reading room computer-gear. It has struck me as analogous to the process of hyperplasia one learns in medical school, if not prerequisite courses in biology. It is not quite cancerous but there is a propagation that seems to exceed adaptive value at times.

By the time I was in fellowship, desktop hyperplasia was well underway. It had become standard to have two PACS monitors per desktop but now a third, smaller screen was often in the mix, since voice recognition was increasingly prevalent and needed some real estate of its own.

Voice recognition wasn’t ubiquitous just yet. My first two jobs after training still had transcriptionists so our desks had recorders on them. They nevertheless still had a separate computer with a third monitor for other purposes (looking things up, accessing work-related email, etc.).

Shifting into teleradiology a few years later, I initially had an undersized desk at home, making the three-monitor setup feel more crowded, especially since telerad companies seemed predisposed to make all the monitors the same (large) size. Perhaps this was done to simplify logistics, but it also made it possible to click a couple of buttons to rearrange which monitors held images versus worklists and such.

Telerad also started introducing other doodads. vRad had a nifty input device for the non-mouse-using hand. They called it the “Grip,” as you’d gently flex your fingers to conform to its shape. Buttons at each of the fingertips could be programmed in such a way that between your two hands and voice commands, you would rarely have to touch the keyboard. I miss that gizmo.

Other telerad additions included webcams or videophones. I have successfully avoided these additions so far since part of the joy of working from home is that I can look like a complete slob if I want. Other consideration included speakers and desktop microphones, unless, like me, you prefer a headset reminiscent of old-timey telephone operators. One may have even added login-security items like card readers or fingerprint recognition pads.

As desktop hyperplasia proceeded, I noticed that an increasing number of the items served no useful purpose for me so this was perhaps a step toward metaplasia or even anaplasia. A telerad company, especially a really big one, can streamline things by having a standard bundle of stuff that gets sent to all rads rather than trying to individualize things by asking docs what they want/need and what they don’t, especially since a rad who doesn’t think he or she will use item X today might develop an appreciation for it next month.

The login security stuff I mentioned above always seems to fall by the wayside. It’s nice to have a single step for logging into work at the beginning of a session rather than having to manually enter user IDs and passwords in half a dozen place, especially if those logins differ from one another. But invariably, the card readers or fingerprint devices seem to develop software conflicts with other stuff or run afoul of regulations. Next thing you know, they’re just sitting on the desktop unused. You never wind up removing them because they might come back into play sometime.

So now I have a fourth monitor for my new job. There is a training session scheduled in a couple of days so I will presumably learn about the extra screen. Maybe I’ll grow to consider it necessary and someday sneer at other gigs that only use three monitors.

Could I wind up with a fifth or even a sixth monitor at some point? The thought could seem laughable, but desktop hyperplasia has been going on for a couple of decades now. Why would it stop? Maybe I’ll start reading mammo again and need higher resolution units. Alternately, maybe I will need a separate workstation with its own screens for tasks such as reading PET scans from another server.

As I mentioned earlier, I currently have a pretty big desk but if any new tech shows up, I’m going to need more room. Could there be a second desk to form an L-shape around me? Maybe it will be a semicircular affair with my swivel chair in the middle or maybe that will be the sign that it’s time for me to retire.

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