Repelling Mediocrity in Radiology

Mediocrity is ubiquitous. Whether we are shopping, working, driving, dining, or discussing phone business, we are frequently confronted by those who don’t know, don’t care, don’t know that they don’t care, or don’t care to know the difference. 

It’s not so much that they don’t like us or want us to get lost. It’s more like they just don’t get it. Or that they’re obtuse or too dense to fully understand how to do it or get it right (whatever “it” is).

It’s likely that we have encountered this in our personal lives and perhaps even considered it with certain of our referring or clinical colleagues. However we should all periodically self-evaluate to make sure others would not similarly characterize us.

It’s been nearly three decades since I finished my residency and though I’ve continuously maintained privileges at one institution, I have experienced various practice models including an independent private group, locums, teleradiology and most recently hospital employment. Regardless of our practice situations, we should always encourage each other to avoid the “M” word - mediocrity.

It is so easy to start sliding. We’ve just been on call so we are tired, not as sharp as usual and just want to finish and get home. We don’t want to take the time or expend the extra effort to be as compulsive as our patients and referring physicians deserve.

You know the drill. Abdomen/pelvis CT for abdomen pain. We go through our standard search pattern and discover an incidental pulmonary nodule. Since most of us read from a PACS work station, we expect comparison studies to automatically load onto the comparison monitor, and when we don’t see a comparison, we assume there is none.

However, we need to be smarter than our machines and remember that they cannot think and will not load the four-year-old HRCT at the bottom of the prior exam list. For any number of reasons, we do not look through that list, so now we cannot confirm stability. So instead of finding the “comparison” that confirms stability, we recommend a follow-up CT according to the Fleischner Society guidelines and feel like we’ve done our job. Sound familiar?

Or maybe you’ve seen a different scenario. PACS work stations are pervasive and well understood by virtually all of us. Likely we’ve all seen a difficult case remain on the work list for hours or until the next day since everyone seems to skip over it. Finally one of the rads that can always seem to get things done will pick it off and then the case gets read. Should not happen, but of course we know it does.

Or maybe it’s something not related to interpreting images, but more with style or lack of consideration. It’s been a busy day and we decide that we’ve had enough. So we ask our colleagues if it would be ok if we left early since we’re not feeling well, have an appointment, or are just tired. We put them in a tough spot since it’s hard to say no to an associate. Over coffee or in the lounge, we frequently talk about lack of personal responsibility across America, and yet do we ever find it creeping into our workplace? If everyone did what we are doing, would the entire group be better off?

We should always be vigilant, periodically self-examine our own habits, and be ready to take evasive action to avoid mediocrity.

Ken Keller, MD, FACR, serves as medical director of the Department of Radiology at Trinity Health in Minot, ND, where has been since an attending radiologist since starting practice in 1983. He is particularly interested in interventional and breast imaging.