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I'm a radiologist and writing helps me make sense of the world.

"My method is to take the utmost trouble to find the right thing to say, and then to say it with the utmost levity" -George Bernard Shaw

Saturday 8 May 2010

Interruptions vs. Consultations

Reflection and navel gazing is something of an increasing personal hobby or affliction, depending on how you look at it. At a mere 30-something years young, I don’t think it is a function of ageing and like to think it a “Physician know thyself” kind of thing. At any rate, the phenomenon of “interruptions” has recently struck me as unique and worthy of discourse.

Interruptions are the many disturbances that a radiologist endures whilst trying to report. Reporting activity is all these days. Gone are the days when the worth of a radiologist was their sound opinions, the eloquence and lucidity of their reports, their humanistic qualities, their abilities as a teacher, researcher and all round good egg. If you ain’t shifting a thousand plain films a month, then you ain’t worth nuffin’. At least that is how it feels, even if your CD denies it emphatically.

This leads to slight tensions arising when you can’t seem to get any “proper” work done. After the nth ward round has taken in your PACS reporting station as their last stop that morning, if you listen carefully you can hear a vague swooshing sound as your reporting target whistles past.

Now there is no doubt that it is annoying to have your intellectual reverie shattered. The possible exception to this is the appearance of a colleague wanting to chew the proverbial radiological fat for 5 minutes. Not only is this usually a welcome break but also I regard it as valuable in-house Continuing Professional Development.

Typically though, the interruption comes midway through the oncology case with monthly pan-body investograms spanning a 7-year history with 16 separate index lesions. However, when using basal ganglia alone to report the seemingly endless in-patient chest films, the prospect of re-engaging the cortex via human contact and conversation is often appreciated.

A knock on the door or polite cough is the usual announcement. The more senior and, well, surgical, the noisier the arrival. Locally we have a neurosurgeon who announces his presence in the form of song, I kid you not. However, some folk sidle in completely soundlessly and you become aware of their presence by some bizarre 6th sense. Sometimes I feel like Joel Halley Osmond when an indescribable sensation alerts me to the presence of 4 soundless juniors hovering behind me.

The interloper typically opens with “Can I ask you a question?”. I have tried the answer “And your second question is?” but most blink momentarily at this repartee, petit mal-like, before launching into their prepared spiel. The other classic of “Can I disturb you?” can be countered with “Didn’t give me much of a chance there, did you?”. Witty as it may seem, no one has ever laughed with 100% honesty at that one either. Their expressions are usually that of bewildered pity.

The task that is asked is usually inversely related to the time you have available. Most mornings will only see trivial queries about Mrs Lard’s bunion-ogram, Whereas the Crackerjack interruption (“Its Friday, its five to five…”) also usually involves someone very young, very complex and very, very sick. On the birthdays of the spouses or beloved offspring, all hell tends to break loose bang-on quitting time whereupon you find yourself mysteriously without a single colleague in the entire department.

A variable length of time later the trespasser has departed, your cup of tea has gone from lukewarm to stone cold and your mental radiology cache has auto-deleted. You sigh audibly, mentally ruminate about the precise dates of your next booked annual leave, and then turn back to the tombstone-like PACS monitors to start afresh.

It is perhaps understandable that radiologists have evolved dysfunctional working practices to avoid interruptions. Some of these changes are working practice arrangements; some are geographical alterations. At worst, I’ve heard of radiologists who shut doors in junior’s faces. However, I think it is also not really on to put rude signs on doors or hide behind locked doors.

I’m not totally decided whether changing reporting behaviour to cope with interruptions is sensible. By this I mean, some radiologists now deliberately come in at odd times to get some plain film reporting done whilst it is quiet. Some even deliberately seek out the quieter PACS reporting stations to reduce the chance of being disturbed. It won’t be long before folk are campaigning to report from home via a teleradiology link for the same reasons. Its only on if the rest of us aren’t left stranded “on the shop floor”.

What I am taking a long way round to saying is that I think we shouldn’t call them interruptions. A change in ethos is needed – we should call them “consultations”. Maybe the clue is in the name but consultants are there to be consulted. It’s not original, but I try and remind our registrars that we should always try to help our clinical colleagues (or at least appear to be helping – a subtle but crucial difference).

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