The Sweet Spot

July 7, 2017

Paying attention to radiologists’ strengths.

Part of my usual running route is alongside a local golf course. Mostly the first hole. As I struggle on by (it’s a decent sized hill), I hear various noises common to golfing, including, of course, the sound of folks teeing off.

It’s pleasant to detect capable players successfully making contact between the “sweet spot” of their club-faces and the ball. Not just because, once in a while, even I can do it, and the results are far better than when this blessed event fails to occur. It’s also on my mind that, the wall of greenery and fencing along the course’s perimeter notwithstanding, an errant, not-sweet shot could plunk a bystander like me in the noggin.

Even those who have no experience with golfing or indeed other activities with similar ball/instrument dynamics (baseball, tennis, etc.) will probably be familiar with the concept of a sweet spot, even if not by that particular name.

Just as the sweet spot of a golf club, tennis racket, or baseball bat is its center of gravity, we’ve each got certain metaphorical sweet spots in terms of our personal strengths, or conditions under which our performance is at its best. And, similar to the athletic usage of the term, it can be tricky to find-and remain centered upon-those metaphorical spots.

In diagnostic radiology, for instance, one sweet spot I often find myself contemplating is the pace at which I read cases. Most reproducibly measured in terms of cases (or RVUs, if you like) per hour. In the fairly-tight range of my sweet spot, I feel capable, productive, and ever-ready for more. Yes, if I find myself above that range, I might feel like I’m having a good day-but it leads to my feeling tuckered out and in need of a break that much sooner.

One might think running below my norm (such as when there are fewer cases sent to my worklist) would make me feel more relaxed, and raring to go if a greater volume of work should subsequently present itself…but instead I find that a sort of inertia takes over, and when the volume picks up I actually have a harder time getting back into my “zone.”[[{"type":"media","view_mode":"media_crop","fid":"61424","attributes":{"alt":"Sweet spot in radiology","class":"media-image media-image-right","id":"media_crop_5076704988242","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7766","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: 133px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©phoelixDE/","typeof":"foaf:Image"}}]]

There are also certain times of day that seem to be sweeter for me than others. Contrary to my expectation, I’m at my sharpest in the last 2-3 hours of my 10-hour day. The first couple of hours, when I’m fresh from a night’s rest and fueled by a tankard of coffee, are paradoxically my weakest.

Notwithstanding my fellowship in Body Imaging, my sweet spot in terms of what sorts of study would best populate my worklist does not particularly consist of chest, abdomen, and pelvis CTs. They’re well within my comfort zone, of course, and I’d never want to be bereft of such cases. But, in large measure due to the peculiarities of the jobs I have held since fellowship, swiftly cleaning up X-ray backlogs seems to be my forte. (Peppered by PET, body MR, and Doppler.)

It’s a happy circumstance and/or wise strategy, then, that my usual caseload from vRad (with whom I work, lest the reader not already know) conforms quite well to this. It has me feeling like I’m functioning at my best, and I’ve got to imagine they feel the same way about my work; things have been kept this way during my past couple of years with them, since my X-ray-centric (xcentric? I think I’ll proclaim that term my own creation) plan was put into action.

From the various rads (and groups thereof) I’ve known and heard from over the years, I get the impression that there could be better recognition of and adaptation to folks’ individual sweet-spots than there generally is.

It seems much more prevalent, unfortunately, for rad groups to instead try hammering their square-peg rads into round-hole roles needed/desired by the group, the individual’s strengths and preferences be damned. Goodwill is often needlessly lost in the process, and potentially valuable efficiencies are never realized as a result.

The ignoring of sweet spots goes the other way, too: I’ve seen rads pressure themselves to deviate from their spots, out of a (sometimes correct) perception that their sweet spot won’t get them ahead career-wise. For instance, an xcentric like myself might worry that he’ll get pigeonholed as the primary reader of such low-RVU studies, and see less of an upside when productivity is assessed, whether it be for annual bonuses (those still exist, right?) or offers of partnership.

A well-organized group might anticipate this, and proactively establish policies to reassure members of their teams: Play to your sweet spot, as long as it can be dovetailed with the group’s overall strategy to mutual benefit, and you need not fear that it will be to your detriment in any way.