Tea leaf readers see…um, change is coming

October 6, 2009
Bradley M. Tipler, MD

It is interesting to hear advocates of healthcare reform describe their vision because big changes seldom go as predicted.

It is interesting to hear advocates of healthcare reform describe their vision because big changes seldom go as predicted. Take the decision to have kids. We read books, watched videos, and had deep husband/wife discussions. We did not have a clue what we were getting ourselves into…for the rest of our lives.

After much thought and consideration, this year I left my hospital practice of 20 years to become a teleradiologist with NightShift Radiology. In talking to friends and family-and everyone had an opinion-I came to anticipate several obstacles the change would bring. Working nights and sleeping days were uniformly expected to completely screw my already borderline brain. How could someone as gregarious as I am work in isolation with no patient or physician contact? Was I really confident enough in my abilities to read every study alone, with no one in the next room to sweat with over tough cases?

None of these materialized. I have absolutely no problem reversing my circadian rhythm a week at a time. And, much to my chagrin, my wife is telling everyone she likes not being “bothered” for a week. The way NightShift is set up, I cover most of the same hospitals each week. And if a doctor or tech calls the company, it rings on my desk, not to an operator. I actually talk to more referring physicians now than I used to, we just don't have lunch together. Although the next room is empty, my PACS and phone are shared with six similar souls around the country, able to give me a second opinion in two mouse clicks. Just like my old group, we commiserate frequently.

What I didn't anticipate is the anxiety associated with having every single case I read being reread within 24 hours. This gives an entirely new meaning to the term “peer review.” When the final read does not agree with my reading, I get a fax the next afternoon containing my report, the final report, and the final reader's comments. These are good radiologists, and their tone is usually friendly and nonjudgmental, but I still feel lousy. Fortunately, most of them have been nonemergent findings, like a 2-cm parotid mass on the lowest slice of a trauma head CT. I still can't figure out how I missed a golf ball.

My new partners tell me this is the nature of the beast. These dreaded discrepancy faxes have had two completely unanticipated effects. First, it is making me a better radiologist. My error rate is around 0.2%, or two per thousand, which is typical for our group. This is a number I did not know for the last 20 years, and now lowering it is a major goal. Second, when I get a junk fax, like one of those travel ads offering a trip to Orlando and Antarctica for $189, I am happy.

So, I listen to all 50 sides of the healthcare reform argument, and I have no clue what to expect. Will my salary go up or down? Will there be more or less work? Is access to healthcare for my family going to get better, get worse, or just get more expensive? Is there anything I can do to affect the outcome? Do I find answers in The New York Times, on Fox News or among the tea leaves?

Like it or not, these decisions are being made in Congress, not in the public forum. And the reality is that in Congress, money talks. The outcome is not foreseeable, but those who are not walking the halls of the Capitol, participating in this process, will certainly feel more pain. That is why giving money to RADPAC, radiology's voice in Congress, is so important right now. Healthcare is going to change and, I hope, improve. RADPAC is trying to defend radiology in the process. Call 1-888-295-8843, or go to radpac.org, get out your Visa card, and invest in your future today. Or just leave it to the tea leaves.