Some Radiology Truisms I Don’t Want to Hear

It was during my residency that I first heard the practice of diagnostic radiology described as “pattern recognition.” See things enough times, and you get the hang of them - no matter how little sense they once made to you.

Well, another type of repetition in our field has been decidedly less helpful to me: trite things that people say to show they’ve been around the block a few times, or to imply that their behavior, while appearing less than brilliant, is in fact predicated upon the wisdom of countless individuals who have said the same thing before.

Perhaps I’ve got a few crossed wires in my noggin, but when I hear these things said for the gazillionth time, I am not overcome by respect for those speaking them. No, my internal dialog screams to the contrary:

“Common things are common.” Thank you, valued referring clinician. Until you said that, I thought the imaging study you were ordering, to exclude a diagnosis completely unrelated to your patient’s history, was an indication of your ineptitude, or at least a severe lack of focus. I now see that you are an aspiring actuary. May I also recommend workup for gastroesophageal reflux? Dementia? Arthritis? Oh, I know you weren’t seeing the patient for such things, but they’re even more common than the tripe you wanted to rule out. And at least as relevant to the history you provided!

“Study ordered without contrast.” Thank you, technologist. Without your valuable addition to my clinical history, I might have looked at hundreds of images, each without a speck of brightness, and had difficulty determining whether there might be a molecule of iodinated stuff somewhere. Seeing none, I might have succumbed to paranoia and believed that the clinician actually ordered the study with PO and IV, yet you mutinously used neither.

Thank you also for not bothering me with the pointless little detail as to why the doc didn’t want contrast used; Now I can go ahead and recommend a follow-up enhanced exam without irritating him needlessly.

“Costs are up, and reimbursement is down.” Thank you, administrator. This cures me of any desire for compensation for my services, and completely erases my recollection of receiving better payment in previous years. Your helpful context washes away my dismay at being in a field where increasing seniority and experience are rewarded by diminishing returns. I am particularly happy to see that your own compensation is evidently in the “costs” category, and not subject to the downward pressure we in the “reimbursement” pool are feeling. It gives me hope that I can get an MBA and enjoy similar protection.

“Radiology (or medicine) is a service industry.” Wow, thanks for the reminder. Other than patients, referrers, hospitals, insurers, accreditation entities, governmental agencies, politicians, administrators, docs above me on the chain of command, other staff surveyed by “360-degree” and peer-review processes, prospective new hires, and some random guy who dialed the wrong number and rang through to my private-phone line, I thought I was working in a complete vacuum. Guess I’d better start behaving myself whenever those folks are around, huh?