Tuesday, December 25, 2007

Laziness, Or Something Else?

AuntMinnie user rogens50 asks if radiologists are "cutting our own throats" with laziness?" I've reproduced part of his post below"

This is a big pet peeve of mine. I have a group in which I think there are very good radiologists. However, I am constantly annoyed at reading reports which are basically just descriptive words and seem to make no effort to get down to the nature of the patient's problem or try to make a diagnosis. This problem is not only unique to my group, buy almost every group in which I review studies. Since we are busier and busier these days, many people in the group treat the reading list like the old "Space Invaders" game in which the only purpose it to shoot down as many enemy spaceships (in this case, patients on the PACS reading list) as quickly as possible. I guess I may be too "anal" about this since I was trained in a residency program where my favorite mentors constantly implored me that "nothing makes you smarter than the old films". In the old days, it was a pain to look at many of old studies and reports which were stuffed in the jacket, but now in the PACS era, all of this information is one or two mouse clicks away. I feel it is the radiologist role to give as accurate assessment as possible as to what is going on with the patient as opposed to generate some generic descriptive report. It seems that there is no academic curiosity or underlying desire to provide any real depth of information to the referring physician and thus help the patient. I can give numerous examples.

Rogens then does cite several situations illustrating his point, such as obvious instances when only the most recent chest radiograph (if that) was reviewed in comparison to the current study. He recommends:
In general, I feel you should try to approach the case is it were you or a family member. Certainly, you may not be quite as diligent as if they were your images, but this is at least a mindset you should have. If you read some of these reports and you and your family member had unnecessary procedures or imaging studies as a result of it, you would feel the radiologist is not doing his job.
And what might the consequences be if we continue?
By generating these kinds of reports, we are taking ourselves away from truly helping the patient. At some point clinicians and administrators may say, "If this is the kind of information I am getting, I might as well get cheaper dayhawks or maybe in the future, send them to India" Therefore, are we cutting our own throats by providing trivial readings?
But even rogens50 realizes that this may not be so easy...
I will admit when I am on call and drowning in studies, I reluctantly cut some, but certainly not all corners, but still try to provide as much information as possible. I try to address situations where the radiologists are overloaded with studies (call) at group meetings and try to correct this problem. Sometimes on call, I feel like I am the Lucille Ball character from the clip where she is trying to keep up on the candy production line. . .

I thought everyone would appreciate the video clip above in light of the analogy.

I'm going to assume rogens is fairly fresh from training. That is not meant in a derogatory manner, but just as a point of speculation. As an aside, my group has hired a number of new kids in the past year or so, and their training and work ethic has been phenomenal. I'll bet rogens is at least up to their (very high) level. Now, I'm assuming he is new because his main thesis demonstrates some naivetee. No, not the part about adding diagnostic value to the reports, and reviewing as many pertinent old studies as possible. There, rogens is spot on. This is a necessary part of our interpretations, and must not be neglected.

No, rogens goes astray with the assumption that the problem is laziness. Really, I don't think even he believes this to be the cause, but perhaps it is the first answer that comes to mind. While sloth may be the answer for some of us some of the time, and for a few of us a lot of the time, it is not the real underlying problem. Rather, the sheer volume we face each day is the biggest obstacle to providing the level of service we think optimal. Based on the "Lucy" remark, rogens understands this, too, but he only mentions "drowning in studies" on call. For most of us, that's just the beginning.

Veteran poster MISTRAD puts it best:

Our workload as rads has so dramatically increased over the last decade, I think we are getting close to our maximum capacity to read studies. Sure, you could read more hours, but frankly for me after a 9 hour shift reading 150 or so studies, I am burned out. I agree with all of your points, but I don't know if the solution, other than hiring more people, is easy.

But, hiring more radiologists means diluting the revenue, and that is the last thing most groups will consider. No, more and more of us are trying to replace shrinking reimbursement with even more volume. At some point, that too will fail, as we will indeed max out on how many studies we can read. Not only do we run the risk of issuing a "typical radiologist mumbo-jumbo, non-commital, uncompared" report, but the faster we push through that heavier volume, the more findings we will miss. At some point, the patients' welfare has got to take precedence over our scramble for one last dollar.

So, rogens50, you have a very valid point. We do need to do better in the areas you outline. But I can guarantee you that in the majority of cases, the problem is emphatically not that we are lazy, nor are we playing games to get the work done and get out. We are tired, we are overworked. I won't be so crass as to claim that we are underpaid, however, and that may be the problem. We may well be so concerned about avoiding being underpaid, that we create worse problems.

Lucy, I feel your pain.

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