Dysrhythmic Radiologists

A number of years ago, in a small British hospital that must remain nameless, there were two notorious radiologists. They were notorious in that they were quite duff in an otherwise sound radiology department. Not quite bad enough to be dangerous but definitely subpar. Both were quite erratic in their radiology reports and became well known for this. They acquired nicknames, with one being known as ‘Wenckebach’ and the other as ‘Atrial Fibrillation’. This was because one was regularly irregular and the other was irregularly irregular.

‘Atrial Fibrillation’ produced quite random radiology reports; some gloriously accurate, some gloriously inaccurate, and the rest somewhere in between. A report bearing the name of Dr. AF could be anything. It could be a lengthy work of fantasy only vaguely related to the images or a concise and accurate verbal synopsis of the radiological findings. Erratic reporting was their hallmark.

‘Wenckeback’ was fond of template reports for normal or near-normal scans but their free-text reports were, erm, garbage, to be honest. For normal scans they used well-constructed templates. These were interspersed with piss-poor free-text reports. Hence their reporting output would resemble the heartbeat in a Mobitz type I arrhythmia: hit, hit, hit, miss, hit, hit, hit, miss. Predictable irregularity was their motif.

Given that incompetence tends to affect multiple fields of behaviour, both eventually came a cropper in matters unrelating to their radiology reports and left their NHS post after only a few years of employment. I am told they have both subsequently enjoyed flourishing careers as teleradiologists.

Of course, it isn’t so much the irregularity of rhythm that can get radiologists a bad name. There is the tempo of working too. Now whilst high output is a prized feature of a radiologist, a radiologist can work too fast. Radiologists working like this can easily miss things. Clarity, grammatical correctness, and copy checking go out the window. Such radiologists might be working at a furious pace, but when you look at their output, it is actually quite poor.

I heard of a hospital that hired a radiologist to come in one weekend to help with their reporting backlog of plain radiographs. This particular radiologist worked 9-5 both Saturday and Sunday and motored through just shy of 2000 radiographs. That’s over 100 per hour for two days straight. Which, at first glance, is nothing short of astonishing.

Except when their work was examined, it was far from impressive. The entirety of one particular chest radiograph report read, “The heart is clear”. Which is, of course, utterly meaningless mumbo jumbo. This type of radiologist is like Ventricular Tachycardia, a dangerously fast rhythm where the frenzied pace of work actually results in very poor quality of output. I’m not saying all such radiologists would benefit from 1000 volts of DC current. But if repeatedly applied to a strategic part of the body, it might improve their output.

The opposite is the Bradycardic radiologist. On the surface, this looks immeasurably bad. A work rate of half that of your colleagues is not a good look. However, a radiologist at the top of their game may have a paradoxical work rate. They look to be pumping out work slowly, but each one is of immense value. For example, whole-body MRI with 4000 images is technically only one scan, same as a CT head with 30 images.

Sadly, a low work rate rarely disguises a radiological hero tho’. It usually indicates someone very inexperienced, singularly distracted, physically ill, or plain burnt-out. Their slow pace of work is a kind of Ventricular Escape Rhythm, indicating all is not well. Rather than punish these radiologists, you definitely need to support them, allowing their woes to settle. They may need extra short-term support, the equivalent of a temporary pacing wire.

Just occasionally the Bradycardia is quite deliberate, due to the radiologist being like a provincial rail service; one track and slow. They faff, they prevaricate, they labour over each study, sometimes taking an intra-report coffee break to reflect on its contents. I’ve seen radiologists leave reports unverified overnight to review in the morning just in case they’ve missed anything. These radiologists are a menace: inflexible, intensely selfish, and immune to feedback. But don’t damn all Bradycardic radiologists; they could be amazing or they could be ill.

A much more prevalent radiological dysrhythmia is persistent Sinus Tachycardia. There is good evidence that getting one’s heart rate up through appropriate exercise several times a day is good for the system. Hence a radiologist that seeks a long and healthy career should be able to mentally drop a gear and, for a short burst, work like their hair is on fire. However, if you are forced to report like this all the time, it is neither good for your scalp nor your cardiovascular system. A charred cranium and a knackered heart from overwork is not a recipe for a healthy or happy life.

Yes, Sinus Rhythm is the goal of all radiologists. A steady and sustainable work rate is a very wholesome goal. It’s also a distinctive feature of a civilised radiology department or cultured organisation. Do you want to work for an organisation that induces dangerous tachycardias, flogging their radiologists half to death? Or would you prefer somewhere with a reasonable workload, where individuals are treasured as the rare resource they are?

Naturally, even those in good health and in sinus rhythm can drop a beat occasionally. Ventricular ectopics represent the inevitable errors that occur in routine practice. But every radiologist suffers from these infrequent and asymptomatic arrhythmias. And those that claim they don’t get ectopic beats are liars.