Ten Little Radiologists and the Significant Digit

May 15, 2015

How radiologists react to new requirements can have a big impact.

Ten little radiologists employed by a hospital constituted the roster of ultrasound study interpreters.

One day, the hospital sent them all a message that, henceforth, all measurements provided in sonography reports were to be dictated to the hundredth of a millimeter.

None of the radiologists noticed the message in their daily tidal waves of notifications and memos, and the hospital followed up with a paper memo a few days later after absolutely none of the ultrasound reports contained the newly mandated decimal figures.

The ten little radiologists each responded in different ways:

The first little radiologist didn’t consider this an imposition or absurdity at all, and adopted the new policy without hesitation.

The second little radiologist didn’t like the imposition, since this would slightly lengthen and complicate his dictations. Still, when he saw the new policy had generated not one but two memos, he shrugged and complied.

The third little radiologist didn’t like this latest intrusion into how he generated his reports, which had never been called out as sloppy, incomplete, or otherwise unhelpful. He also knew just how variable measurements could be, and that claiming to offer precision to a hundredth of a millimeter was naïve at best, deceitful at worst. Further, he didn’t think the sono techs would remember to obtain measurements to the .01 mm, and was annoyed at the thought that he would now have to enforce this rule with them, lest he himself get hassled. That said, he had been around the block a few times, and knew that only bad things would happen if he fought city hall…and knuckled under anyway.

Little radiologists #4 through 10 were of a similar mind, but held out longer:

Number 4 did some digging and found out that the policy was the result of an unholy alliance between a scientifically illiterate administrator and an academician who wanted the extra decimals for his studies. Knowing he’d be reporting the extra decimal one way or another, he wrangled a deal to at least be a participant in the academician’s publications.

Number 5 found out the same thing, but finagled a bit more and cemented a deal whereby he would be a listed author on all of the studies in question without having to put in additional work on such projects.[[{"type":"media","view_mode":"media_crop","fid":"37777","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_7416736697949","media_crop_h":"129","media_crop_image_style":"-1","media_crop_instance":"3743","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"344","media_crop_x":"6","media_crop_y":"49","style":"height: 66px; width: 175px; float: right;","title":"©Pretty Vectors/Shutterstock.com","typeof":"foaf:Image"}}]]

Number 6 had no interest in publications or academics, but instead sounded off about evidence-based medicine to the administrator until she could take no more. Just to shut him up, she agreed to a quid pro quo: He’d report sonos as asked, and she’d give ground on a couple of unrelated other issues he’d been pressing.

Number 7 pretty much never read ultrasound studies other than on a prelim basis for emergency cases, and thus didn’t generate formal reports. He briefly jousted with the administration as to whether prelims even needed to comply with the new policy. The admin wasn’t sure, and made some noncommittal noises on the subject. The rad proceeded to take a gamble and do as he pleased, dealing with flak if he received any. He never did.

Number 8 had no real love for sono in the first place, did more than his share of other work for the hospital anyway, and this finally motivated him to lighten his burden by getting removed from the ultrasound reading roster.

Number nine stood on the principles argued by number 3, but felt far more strongly about them. He further opined that radiologists from any other facility would recognize this for the sham it was, and he would not compromise his field or his professional reputation by being a party to it under any circumstances. The hospital finally told him failure to comply would result in his being labeled as a “disruptive physician,” and subsequent removal from staff. Having no other options lined up, he caved in, with much grumbling. He added this to the list of grudges he would hold against the hospital in perpetuity.

The tenth little radiologist did likewise, but when his position was threatened, he did not back down. He was a huge asset to the facility, and they’d be fools to cut him loose over something as trivial as this. Further, most importantly, the facts were all on his side, and, this being medicine, the bottom line had to be what was best for patients and their quality of care. He was willing to play “chicken.”

Soon after, there were only nine little radiologists.