Problems to Have

March 4, 2016
Eric Postal, MD

Every problem in radiology has a silver lining.

Here we go again…tax season. I try to give a silver lining to the annual chore by thinking of it in terms of problems I am fortunate to have.

When an issue presents itself as a problem, my first thought tends to be to wish it away, if not take action to diminish or nullify it. It’s usually later, if at all, that I wax philosophical (or try to for the sake of my sanity) to “look on the bright side” and recognize that the problem might be a manifestation of a larger, positive situation.

In the case of taxes, no convoluted twist of logic is necessary to see this: The reason I’m forking money over to the government is because I was fortunate enough to earn it in the first place. Granted, this is cold comfort when the “fortunate” situation is that I worked longer/harder during the previous year, earning more…and seemingly as punishment now have to cough some of it back up.

The fact remains that these are indeed problems, especially if not addressed. In the case of taxes, not much imagination is necessary regarding what would happen if I just didn’t pay what I owed.

Radiology, unsurprisingly, is no exception. There are indeed problems most rads (or groups thereof) should want to have, and for each one I can think of, there are probably multiple others. Some off the top of my head:

Too much volume. At the individual level, the problem is perceived as being overworked, running to stand still, having to put in extra hours, etc. If one is a department chair or other such mucketymuck, the problem is about larger volumes turning into backlogs such that referrers or facilities get vexed over waiting longer for reports to get furnished.[[{"type":"media","view_mode":"media_crop","fid":"46503","attributes":{"alt":"optimism radiology","class":"media-image media-image-right","id":"media_crop_2385127039663","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5401","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: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Trueffelpix/Shutterstock.com","typeof":"foaf:Image"}}]]

Lest it need saying, the problem is a good one to have because it means the practice is doing well, attracting more business presumably because it’s doing a good job or at least in the happy circumstance of having no immediate competition to consume the extra volume instead. The alternative-having too little volume-might seem appealing to rads preferring to sit idle for chunks of the day (such as salaried guys with little or no immediate incentive for productivity), but even they should understand that such circumstances would not bode well for their jobs over the longer term.

Why is it always me? This is for the rad who seems to be the “go-to guy” for everything. He’s the one sought out for consultations, by other rads and clinicians who want a second opinion on stuff that was already read by someone else. He gets a steady stream of studies that nobody else seems able (or willing) to read-renal-transplant Dopplers, soft-tissue neck MRIs, exotic nuc med cases, etc., above and beyond his fair share of the workload since it’s known he’s the most productive workhorse in the group. Indeed, he’s disproportionately depended upon whenever a backlog of cases has developed.

Such problems are good ones to have because, each time you’re the only one who can handle a situation, it underscores how crucial you are to the place functioning as well as it does. Call it job security, leverage for contract renegotiation, or political capital within your group, it adds up-and if your current bosses/colleagues don’t provide some kind of counterbalance, smarter ones elsewhere probably will.

Less-than-100% confidence. A nonradiologist physician on another medical forum recently asked what the opposite of a “God complex” was, because he was pretty sure he had it. Only out of postgrad training for a year or two, he found himself frequently unsure of himself, hating the thought of being a bother to senior colleagues with excessive requests for their assistance. Yet hating even more the thought of not doing right by his patients, let alone failing to be the brilliant diagnostician he had hoped he might be when first going into medicine.

This, in particular, is a problem I hope never to be entirely without, as it is precisely the sort of motivation that keeps me learning-from the teammate who generously provided me with a consult on a zebra-case I struggled through, to the journal article I read last month that just happened to give me the answer I’ll need during a diagnostic dilemma tomorrow, to the online resource I’ll consult next week when I have to look up the Fleischner Society guidelines for the gazillionth time.