The Feedback/Venting Button

November 16, 2020
Eric Postal, MD

Venting into the ether when you are "frustravated" can be cathartic.

I wrote last week about a feature of some rads’ workstations: a button that can, with a click or two, send a case from the worklist into a “needs something done” pipeline. More images/recons, priors uploaded, better clinical history, etc.

Even when that button is superbly programmed and supported by conscientious, capable personnel, it’s not a panacea. There are any number of circumstances where a case can be read as-is…although it could have been done better, and it’s not worth everyone’s time and trouble to do anything more for it. Or, nothing is wrong with the case, per se, but the situation surrounding it is, shall we say, suboptimal.

Example, conveyed to me by a rad who saw last week’s column and could have used a button—or something else—to punch during a frustrating bit of time-wastage at his station. It started innocently enough with a chest X-ray, no priors, for the brilliant clinical history of “Abnormal finding of lung field.” Normal case, he moved on.

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A day or three later, he got an addendum-request: The referrer wanted it compared against an abdominal X-ray. For whatever reason, the AXR was not uploaded on the same system as the CXR had been, so the rad had to go back and forth between two programs. Also, while the abdomen’s pics had been uploaded, its report had not, so there was no hint as to what might have been seen that needed comparison (if anything; addendum-requests don’t always make sense).

Interrupted in his hectic day and annoyed, the rad had no idea what was supposed to be compared. The AXR and CXR barely had any overlapping anatomy. He reviewed what little there was, saw nothing of note, and said so in his addendum. Also commented to the staffer who had brought him the addendum-request that the prior wasn’t uploaded to the regular PACS; please make sure to do that in the future.

Fast-forward another day or three: Rad gets another addendum-request for the same case, from the same staffer. Only now is it specified that the addendum is supposed to regard the AXR’s questioning of a nodule in the lung base, and indeed, now the report for the AXR has been provided, commenting on the possible lesion. Even so, the AXR has still not been loaded to the regular PACS, so the rad has to go back and forth again.

None of this should have happened; the original CXR clinical history should have mentioned that the CXR was for a possible nodule seen on a prior study, the prior study should have been uploaded as a comparison in the first place, its report should have been there for review, and if, by some mistake, any of this failed to happen at first blush, it should all have been corrected when the first addendum-request indicated that something was missing.

Looking for the third time, the rad was relieved that there was no real nodule there. But, he could vividly imagine the embarrassing scenario of having to say in a second addendum that, yes, it was there and he’d missed it twice. Further, he’d now spent at least thrice the amount of time he should have on the case, and was pretty ticked off…in part because he had no reliable way to prevent the exact same thing from happening again.

He could have gone on a mission to find someone of authority to tell his tale. But, would it be worth his time and effort? Would they be able to do anything meaningful? Would they be motivated to try? Or would they just write this off as another overworked rad complaining about the imperfect world he lived in?

So, instead, the rad vented to me. As I’ve said more than once in this column, I find it highly flattering that I’ve gotten to a point where complete strangers find it helpful to unburden themselves to me – and gratifying when I can be of assistance to them. Plus, sometimes it gives me fodder for this column.

The rad’s story is far from the first I’ve heard of its type. Pressured to get an obscene amount of stuff done in limited time, with high quality despite suboptimal resources and infrastructure, one is going to encounter all kinds of stumbling blocks. Some have clear-cut fixes, others are murkier, and yet others have no visible solution. But, that doesn’t diminish the frustravation (like that? I combined “frustration” and “aggravation” into my own little sniglet, many years ago) they cause.

I, thus, conceive a new button on a rad’s workstation: Feedback/Venting (F/V for short). Simple enough to implement: The user clicks on the thing, and, immediately, it starts recording him via his voice-recognition microphone as he verbally relates whatever issue he’s experienced. No typing necessary, just click a “done” button when finished speaking. The rad doesn’t have to schedule a meeting with anyone or even get ahold of somebody (in person, or on the phone). It’s immediately available, whenever he needs it.

One or more folks up the chain-of-command in the group periodically reviews these recorded messages. The “efficiency officer” I once described in this column would be an ideal person for this because at least some of the recorded messages are going to showcase aspects of the workflow that could use improvement. Or, “never events” that are warning signs of disasters waiting to happen, which might get shared with the “risk management” people.

Others won’t be, which is why the button is clearly labeled as a vehicle for venting instead of exclusively for constructive feedback. Whoever listens to the messages will know that, and, thus, take everything he hears with a grain of salt. Heck, he might find some of it entertaining. Meanwhile, the frustravated, even angry rad vented into a digital recording—instead of at some undeserving tech, referrer, or (God forbid) patient.

Follow Editorial Board Member Eric Postal, M.D., on Twitter: @EricPostal_MD.

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