A Moment of Your Time

October 30, 2015
Eric Postal, MD

Radiology is much more than getting through a worklist.

Some of the wisdom I gained during my medical education and training was self-taught, rather than gained from the likes of preceptors or texts. One of the more memorable, learned during internship, might be summarized: “Get out while you can.” Or, more succinctly put by a comrade in arms: GTFO.

This lesson was burned into my synapses after a few instances of unnecessarily lingering after my appointed hours on whatever ward I happened to be covering. Socializing with someone, for instance, or using a computer at the nursing station for Internet access. Every second I remained was a chance to be approached by someone wanting to claim a substantially bigger chunk of my time. The classic example being a nurse: “Oh, Doctor, while you’re still here…”

(I must now pause to appease the inevitable outcry from some in our field, or indeed some outside of it who feel equipped to render judgment: Yes, health care is the holiest of pursuits. It is a calling, not a profession. Any entering it should gratefully forsake all notion of personal time, and should feel privileged to devote themselves 24-7-365 [366 during leap years] to the cause. They should feel nothing but guilt for accepting payment, self-flagellate for every penny received above the minimum wage, and gush gratitude for every abuse they experience in the line of duty. Wanting to have a personal life is especially selfish, and a clear indicator one has entered the field for the wrong reasons.)[[{"type":"media","view_mode":"media_crop","fid":"42855","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_3672589763282","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4662","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: 160px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©rafyfane/Shutterstock.com","typeof":"foaf:Image"}}]]

Okay, back to reality. It’s been quite a few years since my internship, when I had a mere 12 hours between workdays to live my outside-of-hospital life (commuting, sleeping, eating, being hygienic, and God forbid exercising and/or communicating with family or friends). I now have the luxury of 14 hours instead…yet, surely to the horror of the sackcloth-wearers addressed above, find it objectionable when the health care machine seeks to claim portions of that time from me.

And it does so insidiously. From uncompensated on-call time to mandated CME hours to licensing/credentialing demands (I currently hold a 500+ page tome of jurisprudence that I’m supposed to be studying in order to get licensure in another state for telerad coverage…and yes, there’s a test I’ll have to take to prove I read the thing).

One frequent offender is something I’ve started to call ESUB (End of Shift Unfinished Business). Anybody reading radiology cases has surely been there: You’re providing coverage till, say, 7PM. Yet at 6:55 you identify pulmonary thrombosis in a patient, or something equally worthy of verbal communication to a clinician.

Now, if you happen to read for facilities or referrers who are organized, on-the-ball, and responsive, this may be no issue at all. I, myself, read for places where getting somebody on the phone can easily be the work of another 30, 60 minutes. One might well wonder how such things can be the routine state of affairs-wouldn’t the involved docs set about working to institute changes to eliminate this gross delay of patient care? (Have a look at my recent entry, “Grudge Match,” to see how quick and easy that battle can be.)

There’s a broad spectrum of responses to ESUB. Some are sufficiently mellow, well-adjusted, or beaten down to simply endure it, and either avoid having anything scheduled for the hours after work (whether social events or just being home for dinner before it’s been sitting at room temp for an hour), or take it in stride when, once again, after-hours plans are scuttled. Others might grind their teeth, loudly exclaim language unfit for virgin ears, or break handy objects.

And then, there’s the potential for identifying frequent ESUB offenders, and trying to do something about them so they won’t be issues in the future. Again, a thing that’s sometimes easier done than elsewhen.

For instance, suppose your workplace routinely bundles trauma cases, such that reading one study on a patient automatically earmarks other cases from that patient for your worklist. Reading a chest X-ray at 6:59, then, might reward you with CTs of the brain, face, entire spine, chest/abd/pelvis, and a raft of additional X-rays to boot. It might not be all that hard to get someone reasonable to reassign those cases…or develop a relationship with one or more of your colleagues working later than you to take the cases, knowing that you stand ready to do the same when the situation is reversed.

In the instance of waiting interminably to verbally convey abnormal imaging results, I’ve yet to find a workaround. One might try leaving the reading area and having the eventual return-call routed to one’s cell phone…but the clinician might then ask about something that can only be answered if one is still able to look at the images. One might have a sufficiently good relationship with a colleague to hand-off the phone call to him…but he didn’t originally read the case, and that’s asking him to take on both liability and the potential chore of second reading the case if the clinician asks about something else. To say nothing of the sticky situation wherein the colleague subsequently discovers that he doesn’t agree with the original read.

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