Dr. Levine is a Professor of Radiology and Advisory Dean in
the Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA, and Section Chief of Gastrointestinal Radiology in the
Department of Radiology at the Hospital of the University of
Pennsylvania, Philadelphia, PA. He is also a Member of the Applied Radiology Editorial Advisory Board.
Laufer, MD, my long-time colleague, mentor, and friend in the Perelman
School of Medicine at the University of Pennsylvania (Penn), recently
passed away after a long battle with cancer. He was an extraordinary
gastrointestinal (GI) radiologist, teacher, and innovator who was
largely responsible for the development and refinement of modern
double-contrast barium studies. Igor also had a Talmudic wisdom in his
approach to radiology and life that he incorporated into an
indispensable set of guidelines known as Laufer’s Rules. Now that
Igor is no longer here, I will present 13 of his rules (in no
particular order) along with my interpretations, so radiologists outside
Penn may benefit from the perspicacity and insights of this remarkable
man and radiologist.
Rule #1: Barium is not a democracy.
a democracy, the majority rules, with barium, not so much. Even if the
majority of images on a double-contrast study fail to show a finding
(eg, because of overlapping loops of bowel), the one image that does is
the winner. In that sense, practitioners of barium radiology aren’t
presidents but dictators, or at best, benign despots. Although this rule
needs no further clarification, that didn’t stop Igor from adding 2
Corollary 1A: We don’t vote on the diagnosis.
Corollary 1B: Especially not with the “residinks.”
Pursuant to Corollary 1B, nothing ruffled Igor’s feathers more than a first-year resident (or residink,
as he called them) who responded to a question by saying, “In my
experience… .” Igor would arch his eyebrows as he cut off the residink
in midsentence and pointed out, “You’ve been on the GI service for 2
days. You have no experience.”
Rule #2: If you don’t do it, someone else will.
could be anything from writing an invited review article to giving a
lecture at a refresher course, reviewing a manuscript, or meeting with
an x-ray manufacturer about the design of a new product. If you don’t do
it, someone else will. What are the chances that another person’s
contribution will be anywhere near as valuable as yours? Besides, you
need the honorarium a lot more than he or she does.
Rule #3: Never ask a question that has an answer you don’t want to hear.
that question is asking for trouble. Better to let sleeping dogs lie. I
myself believe this is one of Igor’s greatest rules, which is why I’ve
never asked the chairman of my radiology department why I’m the only one
on the faculty who doesn’t take night calls.
Rule #4: Start where you are.
originally intended this rule to apply to the interpretation of
old-fashioned x-rays on a conventional film alternator in ancient
Greece, a piece of equipment that became obsolete after the invention of
the wheel (sorry, digital imaging). These alternators had up to 50
boards on which radiographs were hung, and it drove Igor batty when a
residink switched the alternator to the board with the first case rather
than starting where he was. That, of course, is because the cases could
be reviewed in any order, and it made no sense moving the boards when,
as we all know, time is money. Today, film alternators are harder to
find than dermatologists who accept Medicare, but in a broader sense, I
also think Igor was referring to the importance of keeping your focus
and moving forward.
Rule #5: Buy our books.
Igor was referring to 2 books he edited with myself and others, Double Contrast Radiology of the Gastrointestinal Tract and Textbook of Gastrointestinal Radiology, both published by Elsevier (formerly WB Saunders). Though Rule #5 is self-explanatory, Igor added 2 important corollaries:
Corollary 5A: Read our books. (This is optional.)
Corollary 5B: Give our books as Bar/Bat Mitzvah or Christmas presents. (This is not.)
Rule #6: The 10% rule.
rule is based on complex mathematical equations using high-level
calculus and quantum mechanics to show that Igor, by divine right, was
entitled to 10% of whatever food the residinks on GI fluoroscopy bought
for lunch. This may seem unfair, until you remember that the residinks
got to keep the remaining 90%. I have scrupulously adhered to this rule,
increasing my share to 50% to help combat the rising epidemic of
obesity in America’s young adults.
Rule #7: Always buy, never sell.
rule referred to Igor’s time-honored strategy for watching your
financial investments grow. Being in academic radiology, I never had the
opportunity to test this rule myself, but my colleagues in private
practice have confirmed that your assets are likely to grow faster if
you don’t get rid of them. Incidentally, I’ve been asked by my annoying
cousin, the owner of a major league baseball team, when I will have the
financial security to retire. I did the math, and it turns out that to
pay off my debts and achieve financial solvency I will have to work for 7
more years—after I die. But I digress.
Rule #8: Don’t be a cheapskate.
didn’t necessarily mean in financial terms, but as an approach to life.
Wherever you are, whatever you do, don’t be afraid to take chances—to
go for the gusto—which is why, for example, Igor tried bullfighting when
he was a visiting professor in Barcelona. On a personal note, this kind
of thinking got me to join the faculty at Penn as a novice GI
radiologist 30 years ago rather than go into private practice. Without
the compelling case Igor made for my future, I wouldn’t be the
successful academic radiologist I am today. Instead, I’d be lying on
some beach in the Caribbean, retired and financially secure. For that,
Igor, I thank you.
Rule #9: Keep it simple.
at work or home, Igor was a minimalist at heart. That’s why his reports
were shorter than the attention span of most residinks. This minimalist
approach also was reflected in his barium studies. In fact, he was a
huge devotee of minimalist art, a type of art characterized by
simplicity in form and content that enables the audience to view a
composition more intensely by removing distractions of theme and
personal expression. At least, that’s what it says in Wikipedia.
Rule #10: Never give up.
faced a series of devastating illnesses during his life, but what truly
set him apart was his ability to handle adversity with such dignity,
resilience, and grace. When confronted with these monumental health
challenges, he never surrendered to despair or lost faith, seeing each
new setback as a temporary roadblock that could be surmounted through
the power of positive thinking.
Rule #11: Family first.
was more important to Igor than his family. His amazing wife, Bernice,
stood by his side through all of the wild loops of his rollercoaster
ride, sharing with him the hope and faith that enabled them to endure
the many hardships imposed by his cruel disease. And his wonderful
children, Miriam and Jacob, infused his life with the love and support
he especially cherished during his illness. Last but not least was
Caleb, his first grandchild, whom Igor so adored—a ray of sunshine that
lit up his life even in the darkest hours.
Rule #12: Start on time.
was absolutely adamant that teachers in radiology always begin their
conferences on time. Unless you were reading his book, there was no
excuse for making the residinks wait.
Rule #13: End on time.
was even more important than Rule #12. If a speaker went over his
allotted time, he was belittling his students by forcing them to be late
for their clinical services and, by association, belittling those
clinical services and, by association, the attending on those services.
Well, I’d better stop now. I don’t want to exceed my allotted time.