Most radiologists missed the dancing gorilla on the CT scan. A miss is a miss. I hate missing things but know that I do.
Trafton Drew is an attention researcher at Harvard Medical School who has achieved some notoriety for “The Invisible Gorilla Study.” In the original study, subjects watched a video of several people passing a basketball. Half the people wore white shirts and half black. The instruction: Count the number of basketball passes between the white shirts. Half way during the video a guy dressed in a gorilla suit walks to the center of the image, waves his arms around, then walks off stage. More than 50 percent of the viewers failed to see the gorilla.
Drew became interested in radiologists and their ability to identify minute imaging findings in their cave-like habitat. Or possibly, he just wanted to make fun of us knowing that we would be unable to defend ourselves and no one else would care. He devised an experiment in which he placed a black gorilla in a series of lung window images and instructed his radiologist test subjects to play find the nodule.
At the end of the study 83 percent of the radiologists had missed the gorilla in the room.
This is actually fairly easy to understand. The National Geographic series “Brain Games” does a great job illustrating how our relatively low voltage brains have evolved a number of hard-wired perception shortcuts designed to help us make quick decisions to avoid danger. As “Brain Games” points out, these are the basis for magic tricks and allow our brains to be fooled easily and repeatedly. David Copperfield and other famous magicians have made lucrative careers by exploiting these brain short cuts.
The 800 lb. gorilla in the room is the way most radiologists work. I’m not referring to our ivory tower brethren who have the luxury of over-reading residents or specializing in a single aspect of radiology, but the radiologists in the forward trenches, such as myself. We function in a high volume, high stress environment with minimal to no clinical information and constant interruption.
For example, I worked last weekend and sat down at my computers at 6:30 Sunday morning, and with the exception of three 10- minute meal breaks and the occasional bathroom break, I read studies and responded to pages and text messages continuously until 7:45 p.m. It seemed that every time I finished reading a CT, two more appeared on the work list. In retrospect, it is obvious I was reading studies at a desperate pace and that pace did not slow even when the onslaught of studies finally slowed before turning my duties over to the nighthawk at 10 p.m.
I would love to be able to take my time for each study. Even better, I would love to be able to speak with the referring physician and discuss each case with them. However, that is not the world in which I work.
I’m guessing I’m not alone when I say that the speed at which I read studies has steadily increased throughout my career and as the saying goes, “speed kills.” There is no good way to adjust one’s speed to match the volume since you never know when the dump truck that doesn’t go “beep beep” is going to dump on you.
Whether I miss a gorilla of the invisible or 800 lb. variety doesn’t matter much in the end. A miss is a miss. I hate missing things but know that I do.
I’m glad that a Harvard Medical School researcher is studying radiologists and hope he will go on to study the incredible job we do in the most difficult of circumstances when we are tired, stressed, and interrupted.