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How Many RVUs is Rent in Your Head?
Dwelling on a bad experience or episode with a referrer or colleague is never worth the sacrifice of perspective and forward momentum.
I heard the expression from a wise aunt, but the Internet tells me that Ann Landers was the creator of “Living rent-free in your head.” This refers to circumstances where unwelcome stuff lingers in your mind without constructive purpose. Putting this another way, if you have a property to rent out and an unpleasant or destructive individual wants to dwell there without paying, why allow it?
That is easier said than done when it comes to our metaphorical mental apartments. Unless you happen to be a Zen master, you probably have unwelcome squatters all the time. It may be a catchy tune you can’t get out of your head, a social contact or random stranger who did something irksome that you keep thinking about, or a politician or other public figure who will never be aware of your existence but has somehow become a personal demon to you.
Recognizing that you want to evict the offender is a first step, but following through can be a tussle. I have mentioned in previous blogs that our brains don’t do well with that sort of thing. Tell someone they absolutely should not think of a pink elephant, and guess what immediately pops into their head? You can’t really brute force something out of your mind.
So we wait for our thoughts to gradually digest whatever issues we have, or to grow sufficiently bored with the squatter until it is replaced by other things. It would be nice, however, to speed up the process for particularly vexing fixations. Sometimes, we learn a trick or two for the purpose.
Framing the issue as someone living rent-free in your head is one such trick. Suppose someone ticked you off last week, and you are still fuming about it today: You might decide not to give him the added “win” of staying on your mind and use that as leverage to move on.
Such maneuvers can lose efficacy with repeated use, and sometimes it’s useful to put a new spin on them. I found RVUs to be a handy reframe at least when it comes to work-related stuff.
The radiological world provides endless opportunities for things to live rent-free in our heads. Disagreements on QA cases, departmental disharmony on everything from imaging protocols to call schedules, ornery patients and/or their families, and of course suboptimal referrers. It was the latter which inspired my RVU-rent reframe.
My most frequent offenders are clinicians reaching out about already reported studies. Some of them want addenda and some just want to talk about the cases. I emphasize that the vast majority are entirely reasonable folks. They act professionally, often showing abundant respect as colleagues and gratitude for rads’ time/effort. Even non-physicians (who, we might grumble, have no business ordering or inquiring about imaging they don’t understand) generally behave themselves.
Others aren’t so pleasant. They might be starting out with chips on their shoulders because they don’t like what an imaging study revealed, or they have issues with how reports were phrased. Sometimes, noctors inquiring about studies they don’t understand are defensive about their ignorance, and use obnoxious, even hostile behavior as a sort of shield that might cover up their own inadequacies.
Some don’t even seem to care if the rad fielding their call isn’t the one who read the original case but is covering for an absent colleague. They are having a bad day and are ready to abuse whoever picks up the phone. Yet others simply look down their noses at rads, or indeed anybody they feel at liberty to disrespect. There are, after all, plenty of self-important snobs and generally miserable people out there.
It can be jarring to field such calls, especially for a rad early in his or her career who hasn’t had the unpleasant experience before. Especially in the oft-hypercritical environment of health care, a field in which anyone is liable to be accused of wrongdoing or simply avoidable error at any moment, such a rad might reflexively assume that he or she must have done something to earn such abuse.
Even a more seasoned rad might not be able/willing to defend him- or herself. Most of us have been endlessly advised that we’re in a “service industry,” and that we must routinely bend over backwards so as to appease all potential sources of referral. Standing up for ourselves can be a punishable sin.
One of the potential results of this state of affairs is internalizing the abuse and bringing it home as a rent-free mental tenant. Too many times, over the years, I have wound up with endlessly replaying mental scenes of things I could’ve/should’ve said in response, a la George Costanza (although I daresay I would never have done quite as badly as his “jerkstore” retort).
I can recall a particularly unprofessional individual who came the closest anyone ever has to bringing me down to her level. I nearly retorted with venom matching her own but I somehow managed to refrain from doing so. It occurred to me soon afterward that this was over a case I had read “per-click.” I received, at most, two wRVUs for it. Comp per case had already been unreasonably low for quite some time in our field. I wouldnotlet this exceptional shrew of a referrer live in my head for such a pittance.
I took it a step further. I didn’t particularly recall reading any other cases for this individual before, and didn’t expect her to be a major contributor to my worklists in the future. Indeed, I had plenty of other work, and my volumes were steadily growing.
After this incident, I had no reason to doubt that any cases I subsequently read for her would result in similar episodes, especially if she decided that I had not properly groveled and carried a torch of animosity. Maybe she would even decide to make trouble for me with the rad group for which I was reading. Did I need that in my life? Would any amount of RVUs be worth her maintaining a “pied-a-terre” in my head?
No. I decided that it was time for a permanent eviction.
I therefore reached out to the administrative folks for that rad group and advised them of the situation. In the name of avoiding problems down the line, I would not be reading any more studies from this individual. Exceptions could be made, of course, if there was an emergent case and no other rads were available, but otherwise she had lost her consulting privileges with me. Perhaps other rads would read cases more to her satisfaction, which would of course ultimately be in the group’s interest. Heck, let’s concede that my work was deficient and below her standards. Should others more capable not do it instead?
Obviously, that’s an extreme example, and I wouldn’t advise rads to make a habit of “blacklisting” referrers since it does reduce one’s potential workflow and can be complex to administer. However, the mental hack remains a useful one: Any time something case-related stays with and eats at you, think about the RVU pittance you received for the work you already did, and whether it should buy anyone an additional unpleasant moment’s thought from you.
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