Painting The Floors White

There are those who claim a cluttered desk is a sign of genius. Einstein was famed to have one. But, as all good empirical scientists know, correlation is not the same as causation. A clustered desk doesn't indicate genius any more than having a shock of white hair or affecting a Germanic accent.

A messy desk is, in fact, just a messy desk. It's messy because you are disorganised. It's messy because you don't prioritise cleanliness. It's messy because you aren't bothered by appearances. Whereas, I would contend, you should be bothered about a messy desk. Otherwise you come across as some form of slothful degenerate. And all the effort you expend on inculcating your professional reputation is utterly undone by the state of your desk.

Of course, ‘mess’ is a relative term. I am vaguely envious of colleagues whose desks are always spotless and minimalist in content but am not obsessive or organised enough to manage that. Whereas some are so ridiculously cluttered that they spill over onto the floor, enlisted chairs, adjacent desks and windowsills.  If their desk were a cancer, I’d stage it T4 N3 M1.

Similarly, some reporting areas can become horrifically cluttered, usually with bits of paper dominating the debris. To the casual observer it looks like a dog has attacked a book and no one cleared it up. Except that every scrap has been written on. Numerous spidery scripts indicate that several radiologists are to blame, scribbling on anything that came to hand.

Most PACS stations are flanked by a number of textbooks in varying degrees of disassembly. Typically this is an early version of Teddy Keat's normal variants book (a.k.a The Book of Missed Fractures). This usually lies in bits due to a broken spine. Which is ironic, if you think about it.

A potential health hazard

A particular bugbear is dirty cups, often several generations of them around a shared workspace. Some colleagues have breathtakingly poor hygiene standards, where the weeks-old milky coffee remnant acts as some form of culture medium.  Woe betide anyone that accidentally knocks them over and spills the primordial soup within. I looked in one of these cups just recently and I swear something moved in it. I think I had witnessed evolution in action.

Apart from the potential health and safety risks, such jumbled chaos distracts from our primary task. It is also dispiriting; such disarray doesn’t exactly lift the soul. Put this together and you’ve got a pretty poor working environment. The sad thing is that such antediluvian conditions are common place. I’m astonished by what radiologists will put up with.

Which leads me onto the title of this piece. I met a chap who was a specialist in designing production lines. We got talking and I was asking him if he had any advice for us radiologists. He said that if you want a cheap and quick 5% productivity gain, paint the floors white. I frowned, not really understanding. He explained that to paint the floor of an industrial unit or factory, you have to empty the room of its contents. The by-product of doing this is that clutter is removed and you usually put the contents back in where they should be. This act alone is enough to reliably boost productivity.

Just a few months later I read of another individual who painted the floors white. Sir David Brailsford, former performance director of British Cycling and now general manager of Team Sky, insisted on the floors of bike maintenance areas being painted white to spot impurities. He is credited with championing the philosophy of ‘marginal gains’, where small incremental improvements in any process add up to a significant overall gain. 

Brailsford stated that if you broke down everything you could think of that goes into riding a bike, then improved it by 1%, then you’d get a significant increase when you put them together. He has been proved right with undeniable success. Team GB topped the gold medals in the last three Olympics; 5 of the last 6 Tour de France winners were his cyclists. 

It isn’t just cycling. The aviation safety industry is another prime example of this approach. Ditto Formula 1 racing. Many successful business have adopted this and its use is spreading in healthcare.

So, when are we going to embrace this in radiology? When are we, figuratively speaking, going to paint our floors white? Given the challenges faced by radiologists, can we afford not to adopt this approach? In fact, you could get started now. Go and wash up your dirty cup.

Phronesis and the Monkey of Instant Gratification

When I was younger I was a fool. I was cocksure, impatient, anti-authoritarian and lacking social graces. Some of my colleagues may say, “No change there, then”, bless them. At least I now have some insight, I suppose.

It is reassuring to see that the youth of today is similarly afflicted. In some ways it is the job of the young to be pig-headed. We need over-confident and indignant but foolish young people. Mainly as they make the older generations look wise by comparison.

As I enter my mid-career years, I’ve long wanted to be thought of as wise. Who wouldn’t want to have their opinions valued and treasured? The trouble is that it normally takes decades of experience. You just getting the hang of everything, then you retire. Or die, whichever comes first.

At first glance it seems that there are no shortcuts. There is no book, lecture or diploma course in ‘Radiological Wisdom’. So, over the years, I’ve analysed my radiological role models and studied the habits of my more senior colleagues. It soon became clear there are some tricks that can be employed. Specifically, you need to (1) look, (2) act and (3) sound like you are wise.

For starters, appearances are everything. A wise radiologist needs grey hair to give them Authority, spectacles to appear Intelligent and haemorrhoids for an Anxious Expression.

A wise radiologist always appears calm. All the toil, hard work and clever tricks are hidden. They never hurry, always seeming measured and patient. These are definitely behaviours that can be learnt. A swimming swan looks serene but underneath the feet are paddling furiously.

A wise radiologist always says less than necessary. A sphinx-like radiologist can impress merely with the occasional gnomic utterance, particularly if it is an ambiguous aphorism. This is an old gambit – the King James Bible states “Even a fool, when he holdeth his peace, is counted wise: and he that shutteth his lips is esteemed a man of understanding” (Proverbs 17:28).

The reputation of being wise can be lost as well as won. A wise radiologist doesn’t want to fall off their revered pedestal. I was once told the trick is “Never retract, never explain and never apologise”. After all, the right sort of people do not want apologies and the wrong sort of people take a mean advantage of them.

Fundamentally there has to be some substance as well as style. You have to have been there, done that and bought the t-shirt. The three traditional pillars of wisdom are seeing much, studying much and suffering much.

Phronesis is the ancient Greek word for this type of wisdom; a practical wisdom learnt through experience. The meaning is also tied up with being virtuous, moral and ethical – understandably Aristotle was rather keen on the concept.

However, the Road to Phronesis is scattered with hazards and seemingly attractive diversions. The journey towards this life goal is easily derailed. The naturally inquisitive mind is prone to prevarication and impulsive deviation from the task in hand.

A monkey in sore need of gratification

This can be conceptualised as the Monkey of Instant Gratification, a creature that lives at the back of your brain. Most radiologists shackle this creature tightly. We have to focus and work hard otherwise our career stalls. However, this chaotic beast often escapes its shackles when bored. It wrestles the mental controls away from the straight and narrow, looking for immediate fun via all and any channels available. The impulsive actions of this mental simian explain why you can’t resist social media, glossy magazines and other inexplicably attractive deviations, particularly when faced with an absolute deadline for something tedious (i.e. your tax return).

Some find it difficult to control the Monkey. They are extreme prevaricators that can’t stick to the task in hand. Whilst often endlessly interesting people, they are usually quite chaotic. The late great author Douglas Adams was notorious for this. He once said, “I love deadlines. I love the whooshing noise they make as they go by”.

This is not a modern plague. Well, it is but, again, the Greeks had a word for it – akrasia, describing a lack of self-control or acting against better judgement. It isn’t being weak-willed as such. It is more about the established cognitive bias of wanting rewards right now, even small rewards, rather than substantive delayed gratification. For example, people overwhelmingly choose to have £1 now rather than £3 tomorrow. We are hard-wired to do this. We have to fight our inner Chimp not to give in to this.

So, when the steps to wisdom are laid out, it seems within grasp. Every radiologist should be able to achieve this. But knowing the steps is one thing; climbing them is another. For some, the act of looking, sounding and acting wise is too much. We wear our hearts on our sleeves; we are scrupulously honest, freely admitting our Foolishness, shattering illusions of wisdom. For others, conscientious and sustained hard work is too much. We sacrifice the slow accumulation of wisdom for impulsive fun and short-lived bacchanalia. And why not? Life is short.

But for me, there is one deal breaker. If becoming a Wise Radiologist means having to develop haemorrhoids, count me out. So, you’ll have to excuse me, my inner Chimp is calling…