(Not Quite) Giving It Your All


Inadequacy in health care.

One of the happier adjustments in moving to my new home has been the greater number of neighborhood properties with decent-sized chunks of land. My previous pad, and those around it, expressed their lots in terms of feet, not acres or fractions thereof.

With more turf comes more demand for landscaping services…hence, more landscapers. The cast of characters is a motley bunch, but as accustomed to this as I’m getting, I had myself a “double-take” moment the other day.

A ramshackle truck that looked like it was little more than an assortment of plywood planks being held together by whatever the owner could find was putt-putting along, its side emblazoned to inform viewers that, yes, this contraption was part of a landscaping service, and their services could be had for as little as $18 per week.

Now, even if you’re unfamiliar with what landscapers charge, you’ve probably gotten the sense from my tone that $18/week is so below the norm as to raise suspicion (even without the dubious nature of the truck upon which that rate was painted). Still, one can imagine there being some suck-er-homeowners who would be willing to take a chance on subpar yardwork in the name of saving a few bucks.

There are, after all, some tasks one doesn’t terribly mind having done in a half-assed manner. Done incompletely or shoddily, they are still an improvement over not having been done at all. Tidying up a messy room, for instance, or washing a car.

With other matters, half-assed can be worse than, to overextend the metaphor, completely unhindquartered. It’s been my impression that this is most frequently the case when the task: 1) Can only be tried/done once, 2) Requires a lot of effort or expertise (few will have the ability to take it on, or the motivation to try), or 3) Carries a risk of doing harm if performed poorly.

It would therefore seem that there is no room for doing things half-assed in health care, and especially radiology. A subspecialist consultant “mailing it in” would impact not only the quality of the work s/he’s doing, but also that of however many other consultants and primary care types, depending on the work…and those other folks have plenty of potential for half-assing things themselves (giving little or no clinical history when ordering imaging, for instance).

Certainly, people (especially laymen) wouldn’t want to hear of their health care involving anything less than the best of efforts. Such expectations, nevertheless, fly in the face of common sense that, no, not everybody is going to get the absolute best of everything, all of the time.

Thus, it comes as no surprise to anyone who’s spent time in the health care system that there is plenty of half-assing going on. One can only expect (or at least hope) that it will be confined to areas in which it does no real damage.

Such damage is a matter of perspective, however. We rads might have one set of expectations of what corners can be cut, but our referring clinicians might have another. Other subspecialty consultants they involve, yet another. Ancillary staff, even patients getting ahold of their imaging reports, will have additional viewpoints on the matter.

For instance: Reading a bunch of ICU chest X-rays on the same patients, day after day, I might not feel it necessary to measure the distance between an endotracheal tube-tip and the carina each and every time, let alone comment on the precise locations of every other piece of support equipment. If everything looks the same as it did yesterday, I’m probably going to dictate something like “Support equipment positioning remains satisfactory.”

I would not be surprised if some clinician, or especially some paper-pushing, checklist-monitoring administrative type turned out to be of the opinion that, no, my judgment as a radiological physician does not permit me to do this, and set about trying to teach me the error of my ways.

(I could point out that the majority of clinicians trying to read these CXR reports probably appreciate the diminished verbiage of my approach, and/or it makes sense for me to get through these films that much faster so I can take on more important cases in my worklist, like the CT searching for the source of free air I happened to notice beneath one of the intubated patient’s diaphragms. Think that’d convince anyone?)

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