The Reluctant Academician

May 30, 2014

The decision to go into private practice didn’t stop me from trying to teach other radiologists a thing or 2.

Most of the radiologists I know determined for themselves, sometime around residency or fellowship, whether or not they were ultimately bound for work in an academic environment. Some just seem more cut out for doing research, giving lectures and passing on their wisdom to future generations of rads.

It seemed pretty clear from an early stage, that I was not a member of that crowd. Notwithstanding the imperfections of private-practice life (demands of high productivity, suboptimal organization in radiology groups, dishonest senior-partner types, etc.), switching to an academic post has never been a serious consideration for me.

And yet (darn it all!), I occasionally find myself trying to teach somebody something while I’m working. It may be something radiological, or even clinical outside the realm of medical imaging. Why contrast enhancement is a good idea for a prospective CT, for instance (or would have been, had the clinician asked me before radiating the patient); a reminder that the “superficial” femoral vein is in fact part of the deep venous system; commenting on the importance of Doppler during evaluation for torsion.

Responsiveness to my would-be imparted wisdom is, to say the least, variable. To be fair, I don’t expect an overworked member of a hospital staff to be their most receptive at 4 am, especially if part of my message is that they (or someone subordinate to them) didn’t do something as well as might have been. Further, some of them seem to consider me, as an offsite teleradiologist, an at-best-dubious font of knowledge, and easily ignored without fear of consequence. Pragmatism might dictate that I should save my time and breath, and instead focus on generating another fraction of an RVU.

Still, hope springs eternal that sometimes one might make a difference, and such “teachable moments” seem to occur more frequently with those earlier in their careers, such as med students, interns and residents. Forget about transforming them into brilliant physicians-I’ll settle for showing them how to behave a little more like professionals. Or, God forbid, making my life a little easier when their paths cross mine in the future.

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For instance, a couple of weeks ago, I read an abnormal CT on an ER patient. The findings were straightforward, but important enough to warrant a phone call. I spoke with some young doc in the ER who needed a little spoon-feeding, but ultimately he got the import of my communication. Huzzah! Yet another instance of high-quality, coordinated patient care.

Over an hour later, a call came in from another doc who wanted to discuss the case. Since my signed report had been in their system all the while, and the ER staff already knew the findings, I figured this had to mean that the new doc either disagreed with my report or wanted some sort of clarification. Taking the call, however, I found it was an even younger house-staffer (junior resident or intern), on the service admitting the patient. His inquiry proceeded to demonstrate that he had neither read my report nor learned its contents from the ER, if he had indeed spoken with them at all. OK, I told myself, he’s relatively new at this and probably overwhelmed. I proceeded to, once again, have the same conversation I had had with the ER; he turned out to be seeking absolutely zero additional information.

Then he handed me over to his senior resident (without even a token effort to tell her what he and I had discussed). She asked exactly what he had, and again it was clear she had neither read the report nor communicated with the ER. Of course, I gave her the important info (now the fourth time I was describing the pathology, including my original dictation. Who knew the voice-recognition software would turn out to be the least-troublesome recipient?).

She, however, got something extra from me. A bit of advice: If she expected to be treated with respect by her colleagues as her career began, she might consider showing some respect for them and their time. Looking at the radiology report before expecting its author to spoon-feed it to her, perhaps, or getting on the phone herself rather than having her subordinate go through the motions without even trying to debrief him afterwards.

I’ll probably never know if I got through to her. Being a senior resident, her attitudes might already be too entrenched. Still, it felt nice to try.