Dr. Mirvis is the Editor-in-Chief of this journal and a Professor of Radiology, Diagnostic Imaging Department, University of Maryland School of Medicine, Baltimore, MD.
OK, first of all this editorial is not about PET, the nuclear medicine variety. I don’t interpret those studies so it’s hard to have gripes about them. The other pet would be my dog Cindy. She’s old, slow, and has really bad breath, but she is a very affectionate beast so any annoyances are overshadowed by that one strong positive. A little peeve is that she goes back and forth inside and out all day, but what else does an old dog have to do? No, my peeves seem to focus around my job, as in being a radiologist, and no doubt are shared by many of you reading this piece.
Let’s start at the beginning of the day. The reading room is a mess — not a full-blown pigsty, but hardly tidy. Now I am not excessively neat,and I know keeping good order is a hopeless fight against entropy (see second law of thermodynamics). Typically, there are unconsumed food items such as chips (with some ground into the carpet), empty water bottles, ergonomic chairs in anatomically impossible positions, monitors left on financial sites, various open emails or other accounts — often evidence of various strange fixations. I’ve been tempted to order 100 books on any open Amazon account or shoot off some really provocative emails to the chairman. Thumb drives are left in ports, papers strewn about,and so on. When I’m on the 7 a.m. shift I usually clean up the room. I’ve been known to vacuum the floor. My wife wants to know why I am incapable of doing these things at home. The evening and night faculty and residents are responsible for creating the mess.
When I sit at the workstation to start reading, I encounter my next classic peeves. There is food, either crumbs or sticky liquid of some kind, in the keyboard, and there are fingerprints all over the monitors. I would not care all that much about the keyboards, but the keys stick.The fingerprints indicate that someone does not know their radiologic anatomy and must touch the monitor to show findings or ask questions. Usually these culprits are medical students and junior radiology residents, but sometimes they are more experienced physicians as well. I typically threaten to break the fingers of these offenders, at least those of the medical students and residents, if I see them do it again.Since we are next to the ER already, it is a convenient punishment. The keyboard and mouse constitute a seething hotbed of bacteria and viruses. If one were to take cultures from them, I suspect new life forms would be identified. I am not germ phobic, but people with coughs,colds, and vile humors of various sorts could at least wipe these down with the supplied antibacterial wipes or clean their hands periodically with that clear goop that’s all over the hospital. Some residents habitually wipe down the whole room before starting their shifts (somewhat O.C.D. I guess). I try to work shifts with them. Finally, the workstation never quite works properly, and it’s never the same problem twice.
The mornings start slowly so I have time to review my financial news and email. The first calls are about cases from the previous night that are read by other sections. I cannot interpret them to avoid both RVU fights and varying interpretations. Thus, I am the telephone operator re-directing the call. Often they call me back right away because they get no answer. Then I will read the case, sometimes one at the edge of my comfort zone, and risk the wrath of my colleagues. Sometimes I am just the telephone operator as ER radiology is the default number for any problem, personal and otherwise. By the way, the resident works from noon to 10 p.m. so the faculty covers ER radiology solo from 7 a.m. to noon, if you are curious as to why the professor is the answering machine.
As things get busier, the next peeve rears its head. This concerns the never-ending debate about using oral or intravenous contrast for CT.It’s amazing how every day the exact same issue emerges like a ghastly sea serpent to waste an incredible amount of time and tax one’s patience. No matter what is required in the clinical circumstance, something else is requested. As you all know, the default mode is to order everything possible. When I call the ED residents, they seem to think I am trying to “be a nuisance,” “doing the wrong thing,” “showing them up,” “delaying their work-up,” and so on. Sometimes they must draw their attending into the battle. No matter how I try to explain why I prefer a given approach, they think I am trying to get the best of them or decrease my own workload, as if the call involves no effort in itself.After they get to know me or our residents, they’re usually fine with the suggestions, but every month it starts anew.
One of my all-time favorite peeves is the quintessential: “But you did not put so and so in the report.” For instance, I did not explicitly say that the aorta was not torn in the trauma patient. I have many answers to this complaint. The nicest would be: “Well, the aorta is part of the mediastinum, which I stated was normal.” The low level mean response is: “The aorta is torn, but it was going to be my little secret.” The nasty one is: “Yes, the aorta is torn, but we were betting on when it would rupture completely.” It is a peeve, but one worth dealing with for the potential snide comeback opportunity.
Just a few more peeves to mention. When I tell the ED resident that a study is not needed, or is the wrong study to request, or just about anything that shakes them, they get more entrenched and insist on the study as requested. If I maintain my arrogant position, inevitably I get the: “Well, I’ll call my fellow, attending, dean, CEO, or Supreme Being of some sort.” Once I stop quaking in my boots, I suggest that it would be a great idea, so I ask their savior why this resident has requested a study that verifies they are totally clueless about how to care for patients. Often, this comment truncates further discussion. How about this one? A medical student brings in 6 CDs from Elsewhere General that need to be reviewed quickly so the patient can go to the OR, be discharged, or sent back to the referring hospital (rare). The student has no idea about any clinical information, but was asked to take notes on what the radiologists said. The CDs will disappear forever after this encounter despite my effort to have images placed on PACS for second-hand dictation. Finally, many of the studies are repeated anyway so they will be on the PACS for other doctors’ convenience. Someday soon this problem will be resolved, or so I am told, by information technology. Finally, people with too many peeves really get on my nerves.
Now, dear reader, I know these little complaints only scratch the surface of the many potential peeves encountered by those who work in our illustrious specialty. Please email your favorite little work-related annoyance to firstname.lastname@example.org. Try to keep a leash on vulgarity and very personal items. If I get enough, I will share these in a later editorial.