Respect Is Not a Two-Way Street

September 8, 2020

In radiology, in fact, respect is more like a traffic circle.

Not all that long ago, I read a CT that was following somebody’s metastatic cancer. I noted a couple of bone lesions that, unfortunately, hadn’t been reported by either of the two rads reading the previous cases…and the lesions were growing over a course of months.

I’ve referred to this sticky situation in a previous blog or two: It’s generally not good to phrase your report in a way that points an accusing finger at other physicians who have made diagnostic misses. Such statements help nobody except the lawyerly types who are just itching to sue someone for all they’re worth (and then some).

Some rads go further than I would in this regard, not even referencing the previously-missed abnormalities. For instance, if there were a 1-cm lesion last year and now it’s 2 cm, they might simply report, “There is a 2-cm lesion.” Only if pressed on the matter might they, then comment that, yes, it was there before, but has grown.

Over the course of my 20 years (yikes!) in radiology, I’ve developed a few ways of dealing with this issue that I daresay walk a pretty good tightrope of presenting all the relevant information without hanging anyone out to dry. I don’t sweep things under the rug, but I also don’t blatantly put, “This other physician did a bad job and should be sued” on the written record.

Unfortunately, this is precisely what the referring clinician wanted me to do regarding the CT with the bone lesions. It took a while for her to get to that point. First, she wasted a considerable amount of my time (and that of my support staff) by dispatching subordinates in my general direction, then playing petty “my time is more important than yours” type of games with emails and phone messages. I shan’t bore you with the details.

When we were finally speaking with one another and I learned what she wanted—an addendum to my report that would put a nice medical malpractice bullseye on the other two rads, without adding anything to the patient’s care. I explained that the information was already in the report and that I did not see the need for such an addition.

But, she wanted what she wanted, and after we went back and forth a couple of times, she started questioning my “professionalism,” saying that it was my ethical and medicolegal obligation to comply with her wishes. Finally, she threatened to reach out to other people in my rad group. I have no idea whether she ever did—part of me hopes so, since she clearly wasn’t listening to a word I said. Maybe she’d be a little more receptive to someone else.

Part of what made this whole episode galling was that this was not the first time I’d interacted with her. On at least one other occasion I could remember (not long ago, either), I’d spent another considerable chunk of my time assisting her on a different case. She’d been very grateful then. One hopes such gratitude would be a little enduring.

Even without doing anything to “earn” decent treatment from someone, we kind of have it ingrained that respect is a two-way street. The default should be to treat others with respect. A disrespectful response feels like the breaking of a tacit social contract. (On the other hand, disrespectful behavior right out of the gate sets the bar lower; abuse someone, and don’t be surprised if they give you the same—or even worse—in return.) She repeatedly behaved this way over the course of this day, first disrespecting my time, then the quality of my work, and finally me by casting aspersions on my ethics and professionalism.

The truth of the matter is, especially in professions such as ours, respect is not a two-way street. It is a traffic-circle. Perhaps, at a given moment, you are focused on dealing with a specific other driver who should let you onto or off of the circle, but there are others around…some of whom you might not even be aware of. Your actions might nevertheless impact them, and if or when that comes back to haunt you, pleading ignorance of their involvement won’t stand you in good stead.

Whether aware or caring of it or not, she was, indeed, disrespecting others. The two radiologists who she expected me to “throw under the bus.” The subordinates she put in an untenable position by using them as her medicolegal catspaws. Maybe her patient, if the idea was to gin up and direct outrage at physicians other than the referrer herself. Even whatever higher-ups in my group she was threatening to tattle to about her petty issue – did they really need to be dragged into this?

I try to bend over backwards to see things from other folks’ perspective, even when it isn’t in a high-pressure environment such as modern-day healthcare. Imagining yourself in someone else’s position is, itself, a way to find respect for them even when circumstances have initially put you at odds.

There are limits to the strength of this maneuver. Even without the complexities of a traffic-circle, if I see someone driving along on a two-way street who’s grooming themselves in the rear-view mirror or playing on their cellphone instead of watching the road…as another driver, my impression of this individual is that she is not respecting the safety of other drivers, whatever passengers she may be transporting, or, indeed, herself.

Perhaps such a distracted driver, if asked, would offer heartfelt reasons for everything she was doing (those text-messages were of vital importance, for instance). And, perhaps this referrer thought absolutely everything she did was reasonable and, honestly, could not see a fair rationale for my denying her request. Indeed, she was so blinded by what she considered her rightness and my wrongness that she failed to see how her words and deeds were hurting her cause rather than helping it. I have no way of knowing.

In the meantime, I know if I were a commuter and encountered a particular driver along my route whose driving behaviors evinced a lack of respect for others sharing the road—I’d make it my business to avoid her.