Shame!

July 3, 2015

People who deserve shame in radiology.

It’s been a couple of weeks since the season finale for “Game of Thrones.” I figure that’s probably enough time for anyone emotionally invested in the show to have seen it. Still, lest I ruin any surprises…here there be spoilers.

Some background is in order: A major character for the series, having repeatedly demonstrated multiple sorts of character flaws and misbehavior from the start, finds herself on the wrong end of an Inquisition-like situation she enabled. Her atonement is to be thoroughly humbled by walking through a city over which she has reigned as Queen, stripped naked, and accompanied by an imposing nun who repeatedly intones “Shame,” punctuating every third “Shame” or so by ringing a mirthless-sounding bell.

The nun (“septa” in the series) is named Unella, and for those unfamiliar, her no-nonsense visage is depicted alongside this column. A lot of watchers of the series took particular note of her, whether due to the actress’ skill in portrayal, the author George R.R. Martin’s imagination in creating her, or the vision of HBO’s people in transmogrifying her from written words to small-screen portrayal.

I, myself, was not only entertained, but immediately convinced that we radiologists need to make Unella our official mascot, ASAP, before someone else seizes the idea. Entirely too many folks are willfully misbehaving in our bailiwick, and with little if any “shame” as they do so:[[{"type":"media","view_mode":"media_crop","fid":"39013","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4737220079964","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3917","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Image from http://9gag.com/gag/aq2m1mY/a-new-meme-is-born-unella-the-shame-nun-welcome-to-9gag.","typeof":"foaf:Image"}}]]

Referring clinician orders a study for little or no history…like “pain” or “R/O path.” SHAME.

Radiologist finds and exploits a way to “cherry-pick” cases at the expense of his professional colleagues. SHAME.

ER staff sends patient for imaging without having interviewed and examined the individual. SHAME.

Insurer uses a technicality to deauthorize an already-performed imaging procedure, so as to avoid paying for it, notwithstanding that the study was ordered appropriately and provided diagnostic value. SHAME.

Patient turns up for procedure having ignored prep instructions such as being NPO, yet still expects study to proceed and yield diagnostic results. SHAME.

A private-practice clinician buys his own imaging equipment and proceeds to line his pockets with self-referrals, doing 10x the number of studies he ordered previously despite no change in his patient panel. SHAME.

ER staff orders the wrong type of study for a patient because doing it the right way would be more of a hassle for them (waiting for patients to drink contrast, calling in a sono tech): SHAME. (Double SHAME if the ER staff claims s/he’s justified in the name of “throughput.”)

I’m sure a brief consideration of your last week’s worth of work will yield at least a couple instances of someone who desperately needs a prolonged stroll with Septa Unella and her bell. No need to strip the offenders naked for the occasion (although I leave that to the discretion of your fertile imagination).