The Busy Radiologist: An Auctioneer of Time

A couple of weeks ago, I was busily chugging through my never-ending worklist. One of the ancillary staff shot me a message: Dr. X wanted to discuss an abdominal MR I had recently read. The notice contained most of the details I could want: medical record number, date of case, two major points of interest to the referrer, and the referrer’s phone number.

This enabled me to finish the STAT I was reading, get the older case on my screen, quickly recall its details, and specifically look over the items of interest before picking up the phone. Unfortunately, I went to Dr. X’s voicemail and that began a few rounds of phone tag as she was in a busy clinic and only had a moment or two between patients.

(I should point out that the ancillary staff usually go the extra mile and offer to actually get the other clinician on the phone to connect us, but that is not logistically possible all the time. It’s not just a nicety. While they do that legwork, I can read cases or do other doctorly things.)

In one of my messages, I suggested that, if she could specify her queries in TigerText (a useful, HIPAA-compliant text messaging app we use), I could address them there rather than spending any more time with dueling voicemails. Fortunately, she immediately got that one and we finally spoke, resolving all concerns.

Harking back to the beginning of my radiology career, this would have been a much clunkier, inefficient process. We didn’t routinely have cell phones, certainly didn’t have messaging apps for health care, and, at least in the places I worked, didn’t have dedicated go-between personnel for relaying messages. Communications were much more frequently doctor-to-doctor from the very beginning, even if that meant the recipient of the call was totally unprepared for it.

If a rad expressed preferences to the contrary, he or she would likely get scolded that “this is a service industry.” The more of a hassle it was for a referrer to reach you, the greater a chance he or she would refer elsewhere. (Nobody saying this ever seemed to realize the referrer might also consider it a hassle if you had to keep him or her on the line while you dug up the case in question.)

The development and widespread adoption of current efficiencies have, of course, been big drivers of the change in communication culture between rads and clinicians. But I think an even bigger force has been the sheer volume of stuff everybody has to do.

Back then, it wasn’t only possible but routine for us to have all cases read before leaving for home. If you told us that we would be reading 100-plus RVUs per day in the next couple of decades and still never emptying the worklist, we might have freaked out a little. There was a lot more slack in a typical diagnostic workday.

We aren’t the only ones who have gotten busier. Our referrers’ workdays have gotten decidedly less leisurely as well in part because of the aging and less healthy population. A clinician might once have had plenty of time in his or her day to pick up the phone and call our reading rooms to chat about cases (or, perish the thought, stroll down to visit us and go over things in person), but some things had to give.

Since a single radiologist is often the focal point for many such clinicians, I have sometimes envisioned us as air traffic controllers, trying to juggle nearly impossibly numerous issues without allowing calamity to befall any one of them. More recently, the analogy of an auctioneer came to mind.

The auctioneer has a limited number of items he or she is going to sell, and an excess of would-be buyers in comparison. Bidders have the best chance of becoming buyers if they are willing to pay more than their competitors.

We rads have a limited amount of time and an effectively unlimited number of things to get done with it. Each individual who comes to us with a request for some of that time is, in effect, bidding for it. The bids aren’t monetary in our case but are weighed more by importance. A STAT read for a critically ill patient, for instance, comes before a referrer who thinks we measured a lymph node inaccurately.

However, there is another facet to these bids: the time it takes to address these requests. If I hear a referrer insists on a phone call “to talk about a case,” and they won’t streamline the process, such as by telling me in advance which case or what the issue is, I know that call is going to take a while.

Meanwhile, clinicians who bid for my time by using efficiencies like those I mentioned above (ancillary staff to gather information, TigerText) make it quicker and easier for me to give them what they need. I might handle five of those requests in the time it would take to handle that one nebulous phone call. Further, the bite-sized requests can be crammed in between other things on my plate into intervals that would not have allowed me to handle the call.

Even some auctions have recognized the value of these efficiencies. You might have heard of “silent” auctions? They don’t put on as much of a show as a professional auctioneer, but they can get the job done to sell many more lots in a fraction of the time.

Some docs lament changes such as these, wishing for the good old days when physicians had more opportunities to interact with one another in unhurried, professional and, one might even say, dignified ways. They might even blame these efficiencies and those of us who embrace them as part of the problem.

I can understand the sentiment but, to me, it comes across as sitting on the ground and telling sad stories of the death of kings. It’s wishing for a bygone way of doing things that I don’t see returning anytime soon. I would rather mesh well with the adaptive aspects of our current system than rail against them.