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Hammurabian Fantasies in Radiology


While one may occasionally engage in tongue-in-cheek humor about righting wrongs in radiology, maintaining professional perspective remains the order of the day.

A couple weeks back, a posting on radiology social media griped/pleaded that whoever is training ultrasound techs is failing to impart brevity. An increasing number of new grads are cranking out studies with hundreds of (normal) images plus one or more cine loops, and this doesn’t help those of us who are trying to get through a decent day’s work.

There was a chorus of agreement, but it’s no fun just to hit the “like” button or comment “Yes, I concur.” Maybe since I have been consuming sci-fi and horror stuff for most of my life (or perhaps because I had Twilight Zone on my mind after riding the “Tower of Terror” at Disney the week before), I shared a sudden inspiration.

Imagine, if you will, a sono tech who just can’t be bothered to create succinct scans. Somehow, he or she finds himself inflicted with a transducer that progressively provides electric feedback with the increasing number of saved images in an exam. It’s only an unpleasant tingle after a few dozen but starts getting decidedly painful after the 50th image.

One of the other rads who had been entertained replied “Mr. Bond, you have taken far too many pictures.” I got a good laugh, but because I’m clearly not enough of a fan, it took a while to recall that, yes, I had inadvertently borrowed the idea. A quick Internet search provided the particular movie’s title: Never Say Never Again. (No, James wasn’t performing ultrasounds, but if you want to know more, you can watch the flick yourself.)

This wasn’t the first time I had played the game of imagining harsh but effective consequences for misbehavior in the radiological world. I have even shared such daydreams in this blog. Way back in 2012, for instance (it pays to keep records!), I envisioned a rad with a Batman-ish alter-ego stalking an ER doc in the hospital parking lot for excessively radiating pediatric patients.

I am not alone in this although my sci-fi/horror background surely makes me come up with more outlandish scenarios than most. You needn’t mingle with rads all that long — in real life or online — to see them doing similar. Probably the most common is sharing insufficient/inappropriate “reasons for exam” and snarky retorts that we would never actually put in our reports but wish we could. Some examples may include:

• “R/O pathology” … “(Lengthy report full of abnormalities followed by impression. Pathology not ruled out. See above.”

• “Follow-up study” … “Follow up study performed. Thank you for this fascinating referral.”

• “Patient needs a CT scan.”…“Patient’s needs have been fulfilled.”

You might hear docs vent about how insurers, for instance those refusing to authorize reasonable diagnostic studies or therapeutic treatments, ought to have such denials inflicted on themselves or their loved ones. Alternately, some may wish that politicians pushing government-controlled/rationed health care should be forced to use their proposed systems themselves, rather than enjoying some higher-tier VIP plan that is reserved for elites.

It goes beyond rads, and even health care at large. I’ve written before about how neuroscience has shown humans to be hard-wired to appreciate and pursue fairness. A 2004 study used positron emission tomography (PET), for instance, to demonstrate what was then nicknamed the “revenge center” of the brain. If you can’t get fair play to begin with, you might at least want to get back at the unfair player.

Long before we understood such mechanisms, people took it as a building block of civilization: There needs to be a framework to ensure societal fairness, a code of laws and institutions to enforce them. Even back in Babylonian times, there was an instinct that the punishment for injustice should fit the crime. The Hammurabian code had a lot of “eye for an eye” kind of stuff, cutting off the hands thieves had used to steal, etc.

Our systems have gotten more sophisticated, and we don’t go around removing limbs or handing out executions as readily as we once did ... but the instincts are still there. We might express them with humor (even of the gallows variety) or fictionalize them. You might have noticed that the first characters who get tormented, killed, etc. in horror movies tend to be the least sympathetic ones. They commit sins like bullying, theft, and adultery, or are just plain annoying.

It's nice that we’re generally able to sublimate our baser vindictive instincts. However, for some, those instincts don’t just go away and there is every chance that they would return under the right circumstances. I would even argue that certain aspects of society have taken significant steps backwards in recent years.

You don’t have to look very far, for instance, to find folks who insist that justice should be applied inhomogeneously based on people’s differing political stripes, economic status, ethnic background, etc. Just a few years ago, such talk would be considered ugly or even unhinged. Ask proponents and their rationale (if they could put one into words) might have a Hammurabian tint: Uneven justice, in their eyes, might be considered a fair way to counterbalance past wrongs.

All of this brings me around to a final couple of thoughts.

1) By all means, destress with your own Hammurabian fantasies but don’t overindulge. Dwelling on such thoughts might nudge you towards acting on them in ways you will later regret.

2) There are already folks out there who are willing to mete out vengeful justice themselves. They are always ready to identify new targets. No need to live in fear, but it can’t hurt to keep eyes and ears alert for such individuals and give them no excuse to “punish” you.

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