Waiting makes the heart pound faster

December 1, 2007

For two years now, our new house has been under construction. It has been (with the exception of the roof) a very enjoyable process. Only a few items remain to be done, as various subcontractors and our builder come in to finish. The house may be idle all day awaiting an electrician who tackles a 30-minute job, just so the plumber can come two days later, when he has 30 minutes between other jobs, and move the stove. Having no deadline, I'm still enjoying myself.

For two years now, our new house has been under construction. It has been (with the exception of the roof) a very enjoyable process. Only a few items remain to be done, as various subcontractors and our builder come in to finish. The house may be idle all day awaiting an electrician who tackles a 30-minute job, just so the plumber can come two days later, when he has 30 minutes between other jobs, and move the stove. Having no deadline, I'm still enjoying myself.

Waiting is not a popular pastime in the U.S. The majority of complaints I field as department chair are related to waiting, and they seem to be getting less and less reasonable. Our report turnaround time is measured in hours, but the number of "wet reading" requests continues to climb. About 20% of our work needs instant attention.

"Low back pain X 3 years, wet reading please."

How can any intelligent person write such a phrase? Yet what radiologist doesn't see this exact phrase or its equivalent 30 times a day? Medical necessity is seldom a factor. People just don't want to wait.

Scheduling studies has also taken on this fast-food mentality. When our MRI backlog approaches two days, everyone frets that we will lose studies to other institutions. Patients see a doctor for a symptom they've had for months but want their scan scheduled right away. How much experience do we have? How old is our magnet? Is it 0.3T or 1.5T? No one asks these questions. Just, "How soon can I get it?"

I'm guilty of the same mentality when I see a McDonald's and a Burger King by the interstate and make my decision based on the length of the drive-up line. The difference is I know I will get equally unhealthy results regardless of my choice.

At our last department-wide meeting, several staff members complained about having to wait for a radiologist. We don't like this problem either, but with techs outnumbering physicians about eight or 10 to one in most departments, it seems unavoidable. I noted that every time they wait means two interruptions for us: one when they let us know they are waiting, and one when we stop to deal with them. If each of them waits three times a day, I have 50 or 60 interruptions.

I think the key is to make their work as independent of us as possible, but some waiting is inevitable. They suggested hiring more radiologists. I could honestly reply that our case volume per radiologist and our salaries are below the national average, and if they could tell me how to lower one without the other, I would be all ears.

It seems to me that the less we have to wait, the harder waiting becomes. Little delays get amplified. That old geezer driving 30 in a 45 zone drives people nuts. I know, because they flip me the bird when they pass.

Our PACS has increased our throughput and productivity amazingly. Last Thursday, the system got bogged down. It went from closing or opening a case in one second to around eight seconds per action. It was driving me crazy. Then I did the math: 50 CTs, ultrasounds, and MRs at 16 seconds each equals 800 seconds or about 13 minutes in a day. Big deal. I opened Radiomargaritaville.com, put Jimmy on, and decided to enjoy my 16-second breaks. My partner at the wet read desk, where you read 150 plain-film cases a day, had a right to cry.

I have been reading A Year in Provence by Peter Mayle. He and the workers on his property routinely take a two-hour lunch with a jug of local wine. The work waits, and life goes on at an enjoyable pace. I wonder if they need a radiologist.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at btipler@medicaltees.com.