If my wife is right, I am, in fact, a woman. She and other women in my life all maintain that only women can multitask.
If my wife is right, I am, in fact, a woman. She and other women in my life all maintain that only women can multitask. Yet there is published evidence that I and all of my male associates work in an environment that is interrupt-driven with high multitasking loads.1 Superwoman, eat your heart out.
It is not just my professional life that is interrupt-driven. I am interrupted when I’m watching soccer to go and mow the lawn, interrupted when I am doing online research (what is the best site for French wine?), interrupted when I am deep in thought on how to resolve the economic crisis-and no, I was not asleep!
Now I have ample evidence to explain why the other behavior driving complaints leveled at all males (we never listen!) is designed specifically to reduce error.
“Multitasking is bad for patients and interruptions even worse,” I can tell my wife, noting that observations on clinicians demonstrate that doctors are interrupted between six and seven times an hour, that this causes them to spend less time on any given task, and that they fail in nearly 20% of cases to return to the task when they have been interrupted.2
I use this to explain to my wife why the garden gate still consists only of the surrounding frame. And I can tell the chief that I failed to meet my targets because I was interrupted and that I forgot to return to the reporting work list after that idiot from the emergency department burst in to show me his latest triumph of FAST scanning.
The “no interruptions” sign has gone up on the office door and anyone who enters had better watch out. I can now relax in solitude and silence, dim the lights, adjust the ambient temperature, make sure the viewing station is at the right height, modify the mouse and keyboard to minimize repetitive stress injury, swear at the voice-activated transcription, and I’m ready for a high-volume, low-error workload.3,4 And just to show that I view my consultant responsibilities seriously, the sign also says I am available for consultation between 8:30 and 9:00 a.m. each day (i.e., during the daily ward round).
Some radiologists have adopted this stance. Apparently supported by the literature, they lock themselves away, free from distraction, to carry out their primary role of reporting images. They argue that surgeons would not tolerate interruptions during surgery and that a gastroenterologist would complain vigorously if we were to discuss the finer points of a chest x-ray in the middle of a sigmoidoscopy.
They miss the point. While I agree that to be interrupted compromises patient safety and/or privacy, the value of a radiologist, as of all doctors, is the ability to multitask, to work under pressure. Much of our work is to deal with urgent and emergency conditions, to respond rapidly and accurately to complex and evolving problems. If I am scheduled for image-guided intervention in the afternoon, I wish to discuss the indications and the state of the patient’s health in advance of the procedure. And if this doesn’t happen when I am reporting, then when?
What about the “radiologist of the day” approach? This has many advantages, but if I have reported a study, the clinician may to wish to discuss the report with me. If the study falls within my area of expertise, it would be inappropriate to discuss it with anyone else. And if I am sticking a needle, tube, or stent into anyone, I owe it to the patient to be briefed properly prior to the procedure.
The stance also ignores other evidence for the causes of reporting inaccuracies including workload, lack of clinical details, poor image quality, and, indeed, attention span. Those reviewing x-rays at airport security spend only 20 minutes at a time in front of the screen. Could it not be argued that interruptions, if managed well, might improve our performance?
Until patients form an orderly queue outside my office at the proscribed time, with their ailments properly triaged, then interruptions will be an inevitable part of medical and radiological practice. We must seek to manage such interruptions firmly and effectively, finishing the review and reporting of a study, if the report is almost complete, prior to diverting our attention, or setting aside the study with a brief note of what had and had not been reviewed so that we can return to it later without cutting corners.
If we are not able to demonstrate skills in multitasking, time management, and effective communication, as well as great accuracy in image interpretation, then our roles, as some would suggest, can be divided into individual competencies and performed by an ever growing flock of task-orientated technicians.
And the garden gate? Don’t tell my wife that it is hidden under a pile of car magazines in the garden shed! I like interruptions but my shed is sacrosanct…