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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

Tuesday, 17 May 2022

Living in Interesting Times

There is a common myth of an old Chinese curse that runs, “may you live in interesting times”’. Although it isn’t old or Chinese, it seems apt to describe the last few years. I can barely remember the simpler and more care-free times before 2020. All the things we took for granted, all the things we missed so much in various lockdowns are slowly returning. Many of us had never seen viral pneumonitis back then. Many of us never want to see it again.

The covid pandemic is by no means over and it may never truly disappear but there have been many curious changes of the last two years. In the early days of the pandemic I wrote about our early experiences. Two years have elapsed since that time and a lot of medical water has passed under the covid bridge in the interim. Some of this has been revelatory, some of this has been, frankly, a pain in the butt.

The On-Line Life

Everything went on-line. Meetings, teaching, conferences, social life, everything. Initially, this was all rather novel as we discovered, for example, the hazards of leaving our camera or microphone on when we really shouldn’t have. For me, the novelty evaporated within a week. I have come to absolutely loathe on-line meetings with a passion.

I can see the practical advantages of not having to schlep across the country or to another country, specifically for introverts, the mobility-impaired or those with childcare commitments. Having this as an option is a positive step and I hope hybrid conferences are here to stay.

However, there isn’t the engagement of a face-to-face meeting, there isn’t the same emotion or nuanced communication, there isn’t the gossiping over a coffee between sessions. I mean you can sit in your underwear and still take part but that is little solace to a gregarious soul like me.

On-line teaching is very difficult to make effective. Most on-line courses or conferences are just a series of videos. Not all, but most. To me, that isn’t a course or conference. Most people would be much happier browsing YouTube instead. I went to my first face-to-face conference a few months ago and it was a tonic for the soul; so refreshing and reinvigorating.

Delivering on-line lectures is a personal bête noir. I was asked recently if I’d do an on-line lecture and replied, with a twinkle in my eye, that I’d rather do the splits on a barbed-wire trampoline.

Home working

If they had home reporting, many radiologists in the UK were barely seen in the department. Some didn’t have home reporting and rapidly deployed it for all staff. Some didn’t: I worked in the hospital every day, as per normal. Many worked a hybrid pattern of some days at home and some days in the hospital.

The upsides of home reporting are legion: no interruptions, no commuting, flexibility in the working day, decent coffee and the ability to work in your underwear (again, not mandatory). The downsides are also manifold: isolation, fighting with dodgy IT and PACS, wearing out your favourite underwear and increased pressure on your colleagues in the hospital.

This last point is crucial. Those left in the department were snowed under. Clinicians complained when radiologists weren’t available for discussion. Our trainees felt abandoned. In many hospitals, face-to-face checking and supervision evaporated, adding to the misery of lockdown.

It isn’t surprising. This is inevitable when a radiology department has only a … erm … skeleton staff.

Woeful Mitigation

Masks became politicised, almost a partisan topic. Which is clearly a failure of political leadership, with stupid individualism trumping sensible collectivism. And because the UK Govt has declared “covid is over”, the general population has now almost abandoned them. Which is bizarre, given they are the cheapest and most effective method of reducing infection.

Speaking of which, the use of High Efficiency Particular Air (HEPA) filtration has been almost ignored. A proven method of almost eradicating viral bioaerosols, shouldn’t every office, every reporting room and every scanner have a portable device? Why aren’t we retrofitting centralised air conditioning units with them? Everyone benefits from cleaner air. I can’t understand this.

We used masks by the billions and, inevitably, the tonnage of plastic waste has been huge. The focus on hand washing was an unusual choice for a disease spread by aerosol but not entirely without logic. However, the focus on single-use gloves and plastic pinafores was frankly ridiculous. Coming a time when the climate crisis is in full swing, this has been difficult to swallow.

I don’t want to be too political but high level UK Govt policy about contact tracing and private providers of PPE have revealed corruption on a utterly unacceptable scale at the highest levels. Billions have been frittered away. The hasty construction of the almost entirely unused regional series of ‘Nightingale’ covid hospitals was a scandalous failure of logistics. Millions were wasted. No one has been sanctioned or even vaguely chastised. We have been very forgiving. Either that or we’ve been completely hoodwinked. Or both.

The Red-Tape Bonfire

Desperate times allowed desperate measures. Normal rules and normal procedures were ripped up in the name of covid and expeditious decision-making. This brought enlightenment and despair in equal measure.

Redeploying radiologists into the clinical arena was a frank mistake. I wasn’t affected but many were. I know I would have been a positive hinderance and many reported the same frustration. Fortunately this was short-lived and hopefully will never be repeated.

In the UK, annual appraisal and revalidation programme was suspended and the burnt-out mess that is the consultant workforce let out a collective sigh. What happened? The world did not come to an end, the seas neither boiled nor dried and the land was neither ravaged nor pillaged. Some commentators asked serious questions about the validity of this widely-loathed, paperwork-heavy system.

What next?

Although the quiet times of the initial lockdowns allowed a pause to catch up, reflect and solve issues, I’m sad to report that UK coal-face radiology is now in no better position that it was in 2019. All the adulation for the UK’s NHS in the early pandemic, all the ‘clapping for carers’ was, sadly, an empty populist charade.

Our NHS scanners have never been busier, our workforce has never been more exhausted. With the UK economy as it is, there is no magic wand, no secret potion, no Fairy Godmother coming to our rescue. So, until the magic radiology tree starts bearing fruit, all we can do is grin, cope and lobby for more staff and more resources.


  1. Hi Paul, Love your blog which I have only just discovered via your talk at Radiopaedia 2022. I made both a compliment (great talk) and a negative comment on the feedback about the rule about pitch back reporting rooms. Not knowing you at all at that stage I did not realise this was "tongue in cheek". Apologies for my negativity. Barry ("old fart" radiologist, New Zealand)

  2. Reading your thoughts, they seem like mine and for a moment I was feeling less uncertain as maybe there are people similar to me (thank you).