On Good Behavior

October 14, 2016

Making up for misbehaving in radiology.

Sometime between learning to walk and learning to drive, people seem to acquire the concept of being on good behavior. That is, exercising a conscious effort to self comport above and beyond their norm.

It probably gets started in an effort to avoid discipline, or other unwanted treatment at the hands of authority figures…a parent or teacher is in a visibly bad mood, or has been meting out punishments to siblings, classmates, etc., and one goes the extra mile to avoid being the next target.

That kind of preemptive appeasement of outside forces doesn’t go away, although it does get refined. Hearing that salaries or entire jobs are going to be cut, or that a promotion may be up for grabs, might make workers straighten up a bit. Or, knowing that a holiday is going to bring extra vehicular law enforcement on the streets might make folks more likely to watch their speed, or use turn signals.

Another type of being on good behavior enters the fray years after the first, one less focused on appraisal by other people. Instead, it’s more about self monitoring. Since this is a diagnostic imaging column, after all, a perfect example would be a radiologist’s reaction upon discovering that s/he misread a case (or even just that an error is being alleged).

Denial, defensiveness, and whatever other emotional responses may coexist, I daresay most practicing rads react by becoming more vigilant. Whether just with subsequent cases like the one with the misread, or an even more broad based reaction to the rad’s workload.

Same thing goes for any other sort of blemish on performance-signing off on an embarrassing dictation error, followed by taking extra care to proofread subsequent reports. Even nonclinical stuff, like realizing one has been interacting less than gracefully with colleagues and then taking pains to be more diplomatic.[[{"type":"media","view_mode":"media_crop","fid":"52801","attributes":{"alt":"Productivity in radiology","class":"media-image media-image-right","id":"media_crop_4034049389518","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6560","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 187px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Max-Griboedov/Shutterstock.com","typeof":"foaf:Image"}}]]

The thing about being on good behavior is that it’s not one’s baseline. An awful lot of routine behavior is, more or less, functioning on autopilot. Zen-like aspirations to be 100% mindful of every waking moment aside, we tend not to be fully conscious and focused on every single thing we’re doing. First, it would be exhausting, and second, our society pretty much requires us to multitask.

So something happens to put you on good behavior, you upgrade your focus on whatever it is for a while, and (barring a recurrence of the initial incident, such as missing pulmonary emboli in two patients just a couple of days apart) slowly but surely that focus fades. Because you’ve got other things demanding your attention…maybe even other types of good behavior you’ve decided you need to be on.

Sometimes, it’s a zero sum game, and that’s not necessarily a bad thing. If, hypothetically, a rad with perfect performance and amazing efficiency were wrongly accused of a diagnostic “miss,” we wouldn’t want him to fundamentally change anything he did.

Even just spending a few extra minutes on future cases like it would negatively impact his productivity, and even worse would be if his confidence in his skills were shaken and he started hedging in his reports. Best, then, if he recovers 100% from the scare, and even if his productivity takes a hit for a few days while he’s on self-imposed good behavior over something he didn’t do wrong, ultimately he goes back to his baseline perfection.

More often, I do think it’s to be hoped that something is gained from the brief interval of good behavior. We are, after all, supposed to be continuously learning and adapting creatures. If a cycle of good behavior results in even a mere 0.1% improvement of someone’s baseline (“autopilot”) performance, it’s still a step in the right direction.