The Isolated - but Productive - Radiologist

February 15, 2013
Eric Postal, MD

Radiology can be an isolating field. But as our dealings with others get less direct, communications can be misunderstood, unanswered, or lost.

Teleradiology, and indeed noninterventional medical imaging as a whole, can be an isolated field. The stereotype of an unreachable radiologist hiding in a reading room didn't invent itself out of thin air. At times, I've semi-joked about being content to spend each workday in solitary confinement, with a reading station and a stack of cases - as long as there was a fair paycheck waiting for me when I emerged.

Aside from potentially appealing to those with social anxieties and personality disorders, such isolation can give a nice boost to productivity. Time not spent interacting with other humans can be directed towards tasks more easily measured on spreadsheets, like reading cases. Other industries have gotten in on the act; Just think of how many times you have had to navigate automated phone systems in the past year, all of which are geared towards steering you and your time-wasting inquiries away from human employees.

Office related humor (the "Dilbert" comic being a sterling example) portrays this; for instance, character A needs B to do some simple task. Rather than a quick, direct communication followed by action, A and B can go through days or even weeks of missed calls, voice mails, e-mails, memos, and follow-up inquiries to clarify previous missives if they cleverly avoid real-time speech with one another. Do this with a couple dozen other workers and you can quickly ensure that your voice-mail and e-mail inboxes are always overflowing, making you look incredibly busy. Meanwhile, as long as you avoid actual communication, you acquire little or no real work.

This is enjoyable enough until you are the one who wants things to get done. Suddenly, it's like you're trying to collect on a debt - without a gang of thumb-breakers to back you up. Industries have tried to help with this, letting you flag e-mails or voice-mails as "high importance." You can even set messages to automatically send you notifications when they're opened by the recipient, but these things are easily gamed by those so motivated.

Also, you don't want to start overusing them, or you risk diluting their impact - much as a clinician who orders all his studies as STATs. Besides, if these measures really worked, everyone would be using them. And how do you make your "high importance" voice-mail stand out from those left by the rest of the crowd?

If I were trying to make a far-flung enterprise resistant to such inefficiencies, I don't think I'd be too tempted by such mechanical ploys. Technology is imperfect, and motivated humans find ways around its expensive bells and whistles anyway.

Instead, I'd target those humans' motivations directly. It's best if they want to be responsive. Some employees' work is easily objectively measured in this regard, and by measuring their productivity I'd figure out who was getting things done rather than clocking their office-hours with Re:re:re:re:re e-mails.

For less easily measured roles on the team, I might take a page out of the "360-degree evaluation" game book. That is, anonymously-gathered feedback from members of staff having routine dealings with one another, peppered with surveys from external sources (clients) regarding employees who'd served them. Simple questions, like a five-point scale as to how promptly this teammate responded to inquiries, and proceeded to get things done if needed. I would visibly reward (and promote) those routinely doing well, rather than focus on punishing the laggards.

Heaven forbid, I think I'm advocating yet another form of peer-review. Somebody kick me.
 

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