The TAT Contagion

August 8, 2018

Turn-around times used to be important just for critical health issues, but have spread to even mundane tasks.

Patience, it has been observed, is a virtue. One which some have been kind enough to attribute to me…perhaps wrongly. I’m not sure if it’s really patience when one is inwardly dying for some awaited event to hurry up and happen…but manages to avoid putting such impatience on display for others to see. Which is, in fact, often the case for me.

Even if I were truly patient, I don’t know that working as a diagnostic radiologist would have allowed this to continue being the case for all that long. Shades of Nietzsche’s observation about fighting too long against dragons, we’re exposed too much to a certain aspect of our field for it not to rub off on us.

That aspect being TATs. “Turn-around times,” to those of you fortunate enough not to know the term. Even if you don’t, you’ll know the concept if you’ve been in the biz for any meaningful length of time. The specifics can be quibbled about, but the upshot is: How long does it take for a given imaging-study to get done and/or reported?

As with so many things, some aspects of figuring and tracking TATs are reasonable. Stroke-protocol head CTs in the ER, for instance, are dealing with the “time is brain” concept. Getting and keeping TATs as low as possible makes sense, because this can improve outcomes.

Introduce a concept hither, however, and sooner or later it migrates over yonder. If your radiology group (or telerad service) is hustling to toe the TAT-line for head CTs, for instance, sooner or later referring clinicians, administrators, etc. start to want similar treatment for other things. There are, after all, other emergencies, and healthcare in general tends to be a sooner-is-better kind of environment.

The idea then drifts away from actual clinical outcomes and more into logistical issues: The ER wants better TATs overall so they can hurry up and clear patients from their gurneys, either for discharge or admission. The on-call surgeon wants better TATs on his patients so he can know sooner whether he’s going to the OR or if he can head home for the night. And then there are the “VIP” referrers who want their patients to get better TATs than other referrers’ because, well, they’re throwing their VIP-weight around.

The TAT concept thus behaves in a somewhat contagious fashion. Sooner or later, it becomes a global tracking-statistic for the performance of the whole radiology group. One which can be leveraged against them, for instance in negotiations. Your group has an average TAT of X, but there’s a competitor out there that guarantees a mere 50% of X. If you don’t step up, maybe you’ll be out and they’ll be in.

Maybe you, as an individual rad, don’t pay much attention to such things (especially if you were one of those folks for whom the TAT definition above was necessary). One way or another, however, it’s impacted you and you’re probably aware of it to some degree. Exams jumping to the top of your worklist, or calls ordering you to stop what you’re doing and pay attention to other tasks which are perilously close to their TAT-deadline (if not beyond it). Potentially quite stress-inducing, and evocative of a “running to stand still” sensation in your daily grind. Analogies to air-traffic-controller work have been made in this regard.

So if you spend your days bathing in the TAT-waters, is it any surprise some of it will stick with you (sort of like a flesh-in-ink “tat” that won’t easily go away)? You’re constantly hurrying to get things done, things you know you’d probably do better without being poked and prodded to go faster…how long will it be before you start to expect everyone around you to do the same?

Cashiers without hustle, keeping you from getting out of stores and on with your day. People in front of you driving (or walking) slower than you think they should be. Your lawyer or accountant, failing to get back to you when they said they would. Even friends or family, not returning calls or showing late for meetups. If you’ve been infected by the TAT contagion, you’ve hopefully found a way to rein it in so it’s not coloring your interactions with the non-radiological world.

Is there a way to immunize against infection by the TAT mindset? Probably the most effective would be to pursue a kind of “herd immunity” by refusing to play this game in so many aspects of our profession that have no effect on patient outcomes. Of course, as noted above, just saying “no” doesn’t work so well when others are falling all over themselves saying “yes.”