Open Mouth View: Free range radiologists? I don’t think so.

Dr. Weiss is Physician Coordinator, Imaging Informatics at Carilion Clinic and Associate Professor of Radiology at the Virginia Tech Carilion School of Medicine. He is a member of the Applied Radiology Editorial Advisory Board.

Perhaps the most difficult problem confronted by private practice radiologists is getting through their worklist in the face of ever-increasing volumes and case complexity. For decades, radiologists have found that the best way to achieve this was to improve workplace efficiency. Recent PACS and reporting enhancements have proved essential in this task. Sometimes, however, even the best technologies can be insufficient, and other adjustments become necessary.

I no longer have time for a bathroom break during a busy shift. Consequently, I make sure I am a bit dehydrated at all times. Needless to say, I eat at my PACS workstation or not at all. On my occasional forays to the cafeteria for takeout, I will typically choose the shortest food line—not always the healthiest alternative. These adjustments allow me to read for 8-10 hours without stopping, often the only way to keep apace with the workload. Dr. Eliot Siegel of the University of Maryland proposes the 20/20/20 rule. Every 20 minutes focus your eyes 20 feet away for 20 seconds. “Decreases eye fatigue,” says he. “Hogwash,” says I. Who has 20 seconds these days?

Modern fighter jet design has advanced to the point that acceleration g-forces can cause the pilots to pass out without special training and equipment. Similarly, PACS technology has become so fulgurate that the frailty of our own bodies is often the limiting factor in productivity. There has been recent work by radiologists and vendors that should result in improved ergonomics and better user-interface devices.

Absent these advances, current workflow surely is a recipe for obesity and other negative health consequences. It may force me into an early dirt nap, crippled, and deformed by repetitive motion injuries, but it does allow me to finish my assigned cases. My tree-hugging daughter insists on eating humanely treated and fair-traded food, but frankly, I find free range meat a bit stringy. I prefer my beef like my radiologists—nicely marbled. Show me a healthy imager and I’ll show you an under-producing, granola-crunching exercise freak wasting way too much time at the gym. Like chickens, we should confine all radiologists to their cubicles. Why should they be allowed to waste time strutting and pecking up and down the hospital corridors without so much as a hall pass?

My vision of radiological Utopia is an endless kick line of PACS workstations teaming with domesticated radiologists bred specifically for maximum productivity. With proper husbandry and bloodline management, when they have withered and gone there will be more and better workers to take their place. This evolution will very likely take some time to achieve, and I may not live to see its fulfillment.

Already, in these twilight years, I feel my strength and commitment ebbing. I am appealing to the next generation. Step in and pick up the productivity banner. You owe it to our profession. My own hope is to go peacefully in my sleep before getting cluster schtupped by yet another malpractice attorney.