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Why Being a Situational 'Completionist' is Perfect for Modern Radiology


The ebbs and flows of worklists in radiology require equal parts productivity and preservation.

If you have been reading this blog long enough, you know that I have more than dabbled with video games over the years. They were a lot simpler when I got started. Those of sufficient age can think back on "Pong" as compared with, say, Grand Theft Auto.

Part of the evolving sophistication of video games was to offer more challenges than simply beating the other guy or working your way through a bunch of stages to face the Big Boss. Optional side quests became a thing as did finding an assortment of hidden loot. Games started tracking and scoring your progress in these ancillary veins. You might actually win but still be told that you had only done 67 percent of the stuff you could have. (At that point, you would stubbornly go back for the other 33 percent or just consult YouTube to see if anything interesting happens for reaching 100.)

Along the way, games also started offering "achievements" for doing various things, little digital trophies attesting to your greatness. I recall stumbling across one that proclaimed the player a "completionist" for making efforts to delve into every nook and cranny. Evidently, it was already an established term among gamers.

By then, I had long since stopped being a completionist in these things. The video games had gotten sufficiently complex to the point where it was too annoying and time-consuming to track down and do absolutely everything. Still, my attitude adjustment did not come too easily. I was still very much a completionist in other walks of life.

I was one of those kids who settled down and focused on something, like my homework or cleaning my room until it was done. Do some now and do the rest later on? That wasn't my style. An unfinished task would eat at me. That became an issue later. Ten-page term papers don't happen all at once. I suppose that was meant to be part of the lesson.

I think “completionism” (hey, as long as we're using made-up words like "completionist," let's go whole hog) has got to be prevalent among physicians. One doesn't typically breeze into/through medschool without a penchant for learning vast amounts of stuff and regurgitating it on command. A completionist attitude ("I've got to master every last bit of this material") is adaptive if not downright necessary.

It is also the sort of attitude expected of physicians along with other professionals. Don't you want your doc to consider everything and resolve all of your issues? Wouldn't you want your accountant, standing between you and an IRS audit, to be a completionist who is able to defend every penny? Would you be satisfied with a lawyer who got 75 percent of the job done and then seemed ready to mail in the rest?

Radiology may be the medical specialty in which completionism is most expected. All but the greenest rads have heard, many times over, about how they are responsible for everything on the images. One has to be a completionist, or at least have a completionist's diligence and search-pattern, to reliably examine and interpret everything.

Completionism helped select me for this field and enables me to do a decent job now that I am in it. It is no small surprise that it rears its sometimes ugly head in other ways while I am at my post.

Yes, it can get ugly. Health care isn't always the best field for a completionist. The work is never really done. Even if you read all of the cases on your list, more will eventually turn up. That's a good thing if you want to remain needed/employed but if you only feel truly satisfied when you have gotten everything done, you are liable to spend a lot of your time unsatisfied.

You might even feel a little resentful when new work comes your way. It would be akin to a kid who has dutifully cleaned his room, but somebody else periodically comes along and dumps more stuff on the floor.

I have worked in some places where the worklist (or bin of film folders for those who remember) was, in fact, possible to empty. It was very gratifying to do so but living in such circumstances can develop maladaptive expectations if you go on to other places that operate with a perpetual backlog. Folks can notice you getting your stuff done when others do not and respond by developing higher expectations for you sans matching reward.

When the day came that I moved to per-click telerad work, my completionist world got turned on its head. The absolute last thing I should pragmatically want was to deplete my reading list. Having nothing to do would mean zero income while I sat there waiting for new cases to show up.

Still, it did happen sometimes and the completionist in me wound up at war with my desire for productivity. I could sit there simultaneously feeling pleased with my prowess but also fretful and annoyed about how my next paycheck would be smaller than it should be.

Most rads don't have much control over this sort of thing. We get access to however many cases we receive. If that turns out to be a volume we can completely consume, whatever completionist tendencies we have can be gratified. However, just a single case beyond our capacity might as well be a dozen, just like drowning can occur whether one is submerged an inch or a foot below the water's surface. For a completionist, excess cases might indeed feel like drowning.

In an ideal world, completionists would be able to find jobs where getting "all the work done" was achievable, and non-completionists would settle into places where getting caught up would be a "never event." I suspect most would prioritize other things. For instance, I left a completionist-friendly job when it welched on promises of partnership, and another gig offered more money for fewer hours. Furthermore, even if I happened to land a completionist gig that suited me today, the only constant is change, and it might be a non-completionist place in just a few months.

The best compromise I have found is being a "situational completionist." Most of us can't turn our motivations on and off like a light switch but learning to modulate can be a big help. I find that it is best to keep my completionism dialed up as long as there is work to be done. It surely helps my productivity, but I remain capable of dialing it back. For instance, any time I see the worklist is bursting at the seams, I know there is absolutely no way I am getting through it all. Being a completionist doesn't need to include tilting at windmills.

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