These are simple rules of radiology; uber-truths, the very
essence of our dear speciality.
Rule #1 / / Obey the
Rules
Your reason is to knowingly breach The Rules isn’t good enough. It
never will be. It is also forbidden for someone familiar with The Rules to
knowingly assist another person to breach them.
Rule #2 / / Smile
Those who complain the most, accomplish the least. And
remember, nobody likes a whinger.
Rule # 3 / / Keep
your cool
Losing your temper always makes things worse. Anger reveals
weakness of character. Equanimity is hard but worth it.
Rule #4 / / Work hard
It is the radiological trump card, “Yes he may be a sociopath
with BO that makes paint peel but he works hard.” But don’t work too hard. You only have a finite time on
this planet
Rule #5 / / Toughen
Up
Modern medical practice is tough. Patients still die despite
all best efforts. Other doctors aren’t always nice to each other. No one said
it would be easy. Develop a thick hide, become stoical and just get on with it.
See Rules #2 and #3
Rule #6 / / Respect
the machines
Don’t verbally abuse the scanner or let it know you are in a
hurry. They have sensors for that and will shut down. They are particularly
sensitive after 4.50pm, Friday afternoons, on the birthdays of loved ones and
on anniversaries.
Rule #7 / / Never let
a clinician play radiologist
If the request gives specific radiological directions, you
must do the opposite. A request for ‘CT with contrast’ means they get an
unenhanced scan; any request for “obliques” gets just an AP and lateral.
Rule #8 / / Forgive
the sins of the clinician
They are just jealous. There are two types of doctors:
radiologists, and those who wish they were radiologists. After all, we have the
most expensive toys and the comfiest chairs.
Rule #9 / / Don’t be
too approachable
You don’t want to be the one who gets asked to do everything
anymore than you want to be the one that everyone slags off as being grumpy and
lazy.
Rule #10 / / Be a
good colleague
A good radiology department is where you show cases to each
other on a daily basis. Experienced colleagues get their egos checked; younger
colleagues get a helping hand. If you aren’t doing this, you might be part of
the problem.
Rule #11 / / Never
measure anything
A radiologist with a ruler is a radiologist in trouble. If
you can’t measure it with the eyeball-ometer, you are out of your depth.
Accurate measurements honestly don’t matter. The nearest centimetre or so is
absolutely fine.
Rule #12 / / Never
count anything
If you are trying to equate quality or experience with
activity, you are missing the point. You could be doing the wrong thing over
and over again. Anyone who brays about their ‘numbers’ is indeed an ass. If
counting is the sole rationale, you are the wrong person to be doing it.
Rule #13 / / The
default is to say ‘yes’
There are 2 sorts of radiology requests; requests from a
competent and knowledgeable colleague, which you accept; requests from an
incompetent and bumbling colleague, which you accept right now. Saying ‘no’ always involves more work in the long run.
Rule #14 / / Agitation
is not an indication
Lack of planning on their part does not constitute an
emergency on yours. Let them get away with it and they don’t learn the lesson.
Rule #15 / / Always
help the patient
Helping the medical team is helping the patient. The natural
tendency is, of course, to say yes (see Rule #13). Apply the ‘grandma test” –
what if it was your grandma? Sometimes helping means saying no – it might not
be in the patient’s best interests (see Rule #16)
Rule #16 / / Be
damned careful when saying an outright ‘no’
The hardest part about being a radiologist is knowing when
not to do something, when to say no. The clinician has seen the patient, you
haven’t. But if the most appropriate clinician hasn’t seen the patient, feel
free to say no. See Rules #13 & 15.
Rule #17 / / Don’t
study surrogates
Many radiologists spend hours studying, with great
precision, that which does not matter. Cut to the chase; study important
primary outcomes, irrespective of how hard it. Anything else is lazy.
Rule #18 / / Avoid
‘interesting’ cases
They aren’t. They’ve asked everyone else already. And, no,
they don’t have a clue either.
Rule #19 / / Beware
the ‘fit 90 year old’
There is no such thing.
Rule #20 / / Counteract
misjudgement
Staff and patients make snap judgements about you.
Overcompensate. Dress smarter and behave more professionally than you think you
should.
Rule #21 / / There is
no such thing as a radiological emergency
If the patient has a cardiac arrest in the department it
isn’t strictly a radiological matter. Whilst it is polite to show an interest,
they’d be honestly better off with the crash team. Otherwise, you should always
finish your cuppa before the next task. Rushing things causes errors. Stay
calm, stay safe.
Rule #22 / / If you
feel resistance, stop pushing
This is the cardinal rule of interventional radiology. Same
rule applies when cleaning one’s external auditory meatus.
Rule #22 / / Use
words carefully.
Clarity of communication is everything. A good test is
ruined by a poor report. Never, ever write, “Clinical correlation advised”.
Ever.
Rule #23 / / Brevity
is king
The longer the report, the greater the uncertainty. Also,
clinicians won’t read it; anything longer than 4 lines and they skip to the
conclusion.
Rule #24 / / Question
everything
Dogma has no role in radiology. If you never doubt yourself,
you are wrong a lot.
Rule #25 / / Ditch
the stethoscope
Who are you trying to kid? You don’t even know which one is
‘lub’ and which one is ‘dub’ anymore. Oh, and lose the bow tie. Seriously. It
makes you look like a pillock.
Rule #26 / / CT is
easy
Real hardcore radiologists do loads and loads of plain
radiographs (NB they are not counting - see Rule #12). They do them quickly but take pride only in
their accuracy. Anyone who ‘doesn’t do plain films anymore’ is a work-shy fop.
Rule #27 / / Don’t
answer the phone
It is not for you. The more you answer the phone, the more
it rings. Even if it is for you, it isn’t a social call. Ignoring it encourages
face-to-face consultations. These are better for clinical care and certainly a
lot more fun for the radiologist.
Rule #28 / / Stay
safe the easy way
In a high-risk patient, the lowest rate of complications
occurs when you don’t meddle. Contrast nephropathy is unheard of if you don’t
give contrast. Patients don’t exsanguinate from a biopsy that didn’t happen.
Rule #29 / / Get off
the fence
Do not let the fear of being wrong rob you of the joy of
being right. If you absolutely have to equivocate, you are only allowed one
hedge per sentence, “There appears to be a possible nodule” tells much, yet
almost nothing.
Rule #30 / / Don’t pick
fights
Arguing with clinicians is like wrestling with a pig in
mud…after a while you realize the pig likes it. See Rules #3 and #38.
Rule #31 / / Beware
the ‘good’ case
The impressive case that you think you’ve nailed and thus
triumphantly show to all and sundry is only a biopsy away from being a classic
mistake.
Rule #32 / / Don't fret about complications
If you haven’t encountered complications during a procedure,
you haven’t done enough of them. They will still happen irrespective of
preparation, training, skill, carefulness and clinical likelihood. The complications you
worry about don’t happen and the ones that do are unforeseeable. See Rule #5.
Rule #33 / / We are
not the business of exclusion
No test is 100% sensitive. We don’t do ‘rule outs’. Ever.
Rule #34 / / Trust
your clinical instincts
Take a brief history and tailor the examination
appropriately – the patient is trying to tell you their diagnosis. However, if
your barium enema patient starts Cheyne-Stokes breathing just as you are seeing
the caecum properly, you should probably stop.
Rule #35 / / If you
have to fail, fail safely
Struggling is learning. But only to the point that
adrenaline turns brown. Recognize your boundaries and approach them cautiously,
with the cavalry in the wings.
Rule #36 / / Take
clinical details with a pinch of salt
We were all junior doctors; we know why they write the
clinical details that they do. We
understand that clinical examination is fickle - the words ‘shifting dullness’
are 100% negatively predictive for ascites on ultrasound. We understand the
pressures - ‘?SDH’ on a CT Head card merely means the boss’s ward round is
looming. See Rule #37.
Rule #37 / / Don’t
crap on juniors
You can judge a doctor by how they treat those lower on the
medical ladder. Those on the lower rungs need a hand up. A radiologist can
provide help and education. Education, however, can be delivered pretty
assertively. Especially at 3am. See Rules #2, #3, #9 and #36.
Rule #38 / / Aggressive
clinicians need your help
If a doctor gets rude and shouty, they are usually (i) out
of their depth, (ii) unsupported and (iii) worried about their patient. See
past the emotion and try to help. Persistent offenders need showing the door
and reminding, “My scanner, not your scanner”. See Rule #3.
Rule #39 / / Know
loads
The job of the radiologist is to explain every pixel. Not
just hazard a guess, but to know categorically. If you can’t explain something,
you aren’t as good as you thought you were. See Rule #4.
Rule #40 / / Never
offer to eat your pants
You might be so totally convinced in your diagnostic
accuracy that you offer to do something silly if you are wrong. Sure as eggs
are eggs, you will be tasting cloth sooner than you think.
