Radiologists Have Too Much to Do

October 30, 2018

Radiologists are finite, and it’s time to admit it.

Some folks boast about how good they are multitasking, and even mock others who can’t (or choose not to). There have also been more than a couple of thoughtful write-ups about how an awful lot of multitaskers aren’t actually doing quite as good a job as they think they are.

It is nevertheless an unfortunate reality that we rarely enjoy complete protection from intruding distractions when trying to focus on a single task. Which leaves two options: Defend against such incursions, or field them efficiently enough to harm the primary objective as little as possible (and that includes setting aside the primary in order to deal with the other matter).

Some defenses are more effective and/or adaptive than others. I recall, once upon a time, hearing of a rad who got sick of intruders in his reading room and actually closed/barricaded his door so he could get some cases read without interruption. That would certainly be effective (at least until someone broke down the barricade) but not the most adaptive for someone wishing to remain in good graces with the rest of the hospital.

Most folks, even non-rads, would agree that it is a reasonable thing to want some undisturbed time to get your work done. The problem is that many of those who present disturbances have massive blind-spots when it comes to disruptive effects. They either see themselves as not being all that much of a distraction, or feel that their imposition is for a sufficiently good cause-that it’s “worth” the radiologist being put out.

More from the author: Dealing With Stress in Radiology

The fact remains that rads are mortal, finite beings, and can only serve so many masters at once. Each interference takes a slice out of the virtual pie of the rad’s potential workload and/or quality of work being done. And that isn’t confined to folks coming to the rad’s reading-room or ringing his/her phone with their various issues.

Another, more insidious interference can sneak in-and is harder to repel. It often comes from our own colleagues, such as in the form of directives from group-leadership. Or from regulators and policy-makers who have nowhere near the education and training of a physician, let alone radiologist-yet see fit to reach in and impose their will, en masse, upon the legions of rads who are collectively trying to handle the ever-increasing volume of imaging work upon which healthcare depends.

If you read cases with any regularity, you’ve experienced precisely what I’m talking about. There are any number of required policies and procedures, including rules about how to construct your reports, that you have to remember and adhere to if you don’t want hassles (or worse) down the line.

And each item that deviates from how you’d normally handle things is taking a little slice away from your attentiveness and focus on reading cases well (and in decent volume, lest it need saying).

Suppose an item just takes up 0.1% of your wherewithal. And it’s for a really, really worthy cause. Well, hey, that still leaves you able to live up to 99.9% of your radiologist potential, so maybe you should be willing to live with it.

Except it’s never just one thing. Rather, it’s just one more thing-piled on top of other “just one” things that accumulated over the preceding months and years. Some might have been around longer than you’ve been in medicine, so you’ve never even experienced radwork without them. In a way, they’ve made sure you were never operating at 100%. Add them all up, and maybe you’re effectively at 90% right now. Give it another decade, and some more will be in the mix: Maybe then you’ll be at 85%.

A few such items, off the top of my head: Required phone-calls to communicate results of imaging (regardless of whether positive or negative) with ordering clinicians who didn’t even want, let alone request, such calls. Mandatory measurements of lesions such as in the thyroid, liver, or kidneys, when such measurements have no clinical interest whatsoever, purely for the satisfaction of CMS’ “MIPS.” Other specific verbiage of no clinical value (sometimes, in fact, confusing referrers), just to ensure that reimbursement for imaging won’t be denied.

Once these various intruders are allowed into our business, it’s effectively impossible to get them back out. The time to repel them is when they are first brought up. And it’s not easy to do, especially since the folks best suited to defend the fort tend to be administrative or professional-society types-the people who do far less of the actual clinical work than most of us (sometimes none!). They don’t stand to have these interruptions besetting them for the remainder of their careers. Taking the path of least resistance has no overt downside, as far as they can see.

Related article: Should Radiologists Work in Shifts?

But there is a downside, and it’s not just rads feeling put upon. If you’re practicing radiology at, say, 90% of your potential, that’s as much as 10% of patient care that’s being allowed to fall by the wayside. While you’re remembering how to jump through the hoops that CMS set up for you, maybe you forgot that one item in the differential diagnosis you reported that would have led to a patient getting the treatment s/he needed. While you were calling in that negative head CT to appease the hospital’s stroke-protocol (and annoying the ordering clinician who wanted no such call), maybe a surgeon who wanted to discuss another case with you got put on hold and hung up in frustration- thereby not having a clinically-important discussion with you until hours later, if at all.

However brilliant and industrious we (or others) may like to think we are, rads are finite beings, with only so much to go around. Treating them as if they were bottomless wells is inviting a truly bottomless well of “unforced errors” to occur.