Grudge Match

October 9, 2015

The internal battles in radiology.

The age-old opponents faced off once again: Irresistible Force and Immovable Object.

In this instance, the Force was a recently-trained radiologist. Highly intelligent and hardworking, trained at top-flight institutions by the very best academicians in the field and diligent about keeping up with the latest research.

Also highly principled, and dedicated to practicing the best medicine he could with the iron will to see it through. Early in his career, he’d seen that health care was no different from other fields in that it was all too easy to compromise quality in the name of practicality or expediency. “Choose your battles wisely,” in his mind, implied ceding others, and he would not be taking such easy ways out with his profession and, more importantly, patients’ well-being on the line.

No surprise, then, that this Force’s nemesis, Object, was the imperfection with which health care is rife. Equipment decidedly non-cutting-edge, or so faulty/obsolete it should have been taken out of service years ago. Facilities with outdated protocols from yesteryear, or that had never been appropriate in the first place. Referring clinicians insisting on things being done their way, no matter how demonstrably wrong. Techs unable, uninterested, or unwilling to modify their approaches for optimal imaging study quality.

The Immovable Object, therefore, enjoyed an advantage over the Irresistible Force, in that it wasn’t exactly a single opponent. One might consider it a modern-day Lernaean Hydra, in that no matter how many of its manifestations the Force might subdue, more would arise. One might also consider it a lopsided tag-team wrestling match.[[{"type":"media","view_mode":"media_crop","fid":"42185","attributes":{"alt":"radiology battle","class":"media-image media-image-right","id":"media_crop_1550190574530","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4540","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: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©serazetdinov/Shutterstock.com","typeof":"foaf:Image"}}]]

The Object’s other distinguishing characteristic, both advantageous and otherwise, was that it was something of a one-trick pony. While, as noted above, it was protean in its manifestations, its main means of challenging the Irresistible Force was inertia.

That is, invariably the battles between Force and Object were a matter of the radiologist finding something objectionable in the status quo, and trying to do something about it. All the Object needed to triumph would be to stand pat and withstand the Force’s efforts to bring about a change. The Object would not fatigue or become dispirited, whereas the Force might.

Part of what made this Force more Irresistible than most, however, was that it was not a one-trick pony. Contrary to his nom de guerre, the radiologist did not simply apply the social equivalent of brute force to each of these bouts, but varied his approach. Yes, persistence was important (a Marvel-comic character-I forget which-once said “If you hit something in the same place enough times, sooner or later it’ll fall down”), but not a panacea.

So a facility for which the radiologist read would routinely perform unnecessary triple-phase CTs on all trauma patients, young and old. The radiologist tried submitting feedback to the facility. He tried including statements (diplomatically worded) in his reports on these cases. When speaking with clinicians about important findings on these scans, he made mention of the excessive dosage issue.

As objects tend to do, the issue withstood many of these efforts without perceivable effect. A less-irresistible Force might indeed have given up and moved on to expend its efforts on more easily-achieved goals. Indeed, this particular contender often felt frustration and even despair…but recognized that these battles were matters of attrition.

He never knew which attempt might pay off, or for that matter whether a given effort might succeed the first time he tried it or the hundredth. Rather than think, “How much longer can I put up with this,” he focused on, “What haven’t I tried yet?” Or, “What haven’t I tried in awhile?”

Similarly, he didn’t view a given instance of the Object as truly Immovable, just as he didn’t consider an umpteenth-confrontation with it as a rematch following innumerable losses to it in the past. Instead, it was just another round in a prolonged contest, and his greatest asset, the thing which made his efforts as Irresistible as they were, was his willingness to stay in the ring for as long as it took.