Radiology Self-Appraisal: Bane or Boon?
While perspective is important for reining in an unrelenting perfectionism here and there, the inner drive for achievement can serve as fuel for consistently high quality over the course of a radiologist’s career.
“Follow up your own cases.” It is advice I have seen many times over the years, usually in the name of seeing the impact of your work and learning from mistakes.
Once upon a time, I worked in a place that tried to make it part of the workflow. All other things being equal, if you had read the last scan on a patient and they had another, it would come your way. I didn’t much care for it then because they didn’t have a balancing mechanism in terms of productivity. You just wound up with extra cases to read.
I have never worked anywhere else that made such efforts, but I have come to really enjoy reading my own follow-ups for a few reasons other than the aforementioned learning value. Picking up a case and recognizing my verbiage in the prior report is always a happy blip in my day.
As such cases have accrued over the long term, however, I have come to realize that I can be a really harsh radiological critic, at least when it comes to my own work. This isn’t the case so much for reviewing work of other rads.
If you have read my blog for the long haul, you know I have plenty of thoughts about how QA is implemented. That said, I do make use of the system. If significant mistakes are made, they warrant feedback (and good work needs to be called out too).
Spend enough time at workstations and you get a feel for what rises to a level that will make you hit the QA button. I have worked alongside way too many people who seem to treat it like a speed bag, so I lean heavily in the opposite direction. It’s not meant to be like sitting with a junior resident who is still learning search patterns and should have every little inconsequential “miss” addressed so he or she gets into good habits.
You might call my attitude “forgiving” when it comes to reviewing the work other rads have done. You wouldn’t if you could hear my thoughts when I am following up my own cases. Why didn’t I give details for this benign lesion instead of just calling it stable? How could I have ignored that artifact instead of saying it might be a genuine abnormality? (It was an artifact and isn’t there now, but how could I have known that?) It can be a little mentally exhausting.
This might come across as being prideful. Why should I hold myself up to higher standards than I would anyone else? That sounds suspiciously like considering myself better than them. At the very least, it sounds like an unhealthy bit of perfectionism.
In that light, maybe I can forgive myself that I am not alone. I have written about perfectionism in the medical field before. We are kind of selected and honed for that trait.
A lot of docs reading this can surely cast their minds back to exams they took during schooling and training, scoring well above the passing mark and even in the upper percentiles of their peers even if they didn’t quite achieve the #1 ranking or a perfect score. Some were, I trust, able to unreservedly rejoice. Good for them.
By contrast, many of us beat ourselves up a bit, focusing on what we didn’t achieve more than what we did. How did I miss those points? Why didn’t I outrank the competitors above me, however few they might be?
I can tell you that not a single time did I cast such thoughts toward any of my classmates. Never did I think: “Hey, fellow student, how did you only manage to score an A-minus?” The crucible of my perfectionism was for me alone.
Is it any wonder that such mental habits persist years, even decades later? For rads, they are not limited to diagnostic accuracy. If, for instance, I “know” I have been able to do 11 wRVU per hour, and I find out that I averaged 10.3 last month, I am likely to chastise myself for slacking, worry that my performance is degrading, etc. It won’t matter at all if you remind me that other rads in my group average around 9 wRVU per hour.
There are a couple of ways to deal with this, once one has recognized it in oneself. If it is too nerve-racking, one might work at tamping it down with things like introspection, meditation on the matter, even anxiety reduction exercises or therapy.
For a lot of us, however, it can be a useful tool that is worth the unease it creates. It helped propel us to whatever heights we achieved (including those strong test scores of yore). Being a little hypercritical of myself helps me keep my edge and always pushing to do a little better. At the very least, it will help me stave off losing ground as age and entropy try to have their way with me.
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