Radiology train wrecks, or how to ruin imaging and your career

For radiology trainees, learning how not to behave is just as important as learning the right way to conduct yourself in the imaging suite. In fact, radiology's image to the public may depend on trainees learning what not to do.

The standard six interrogatives, applied to radiology, were a handy way for radiologists Dr. Richard Gunderman and Dr. Cheryl Steiman from Indiana University School of Medicine to illustrate unprofessional behavior in the imaging workplace.

"We posit that many breaches of professionalism result in part from a failure to remember who, what, when, where, how, and why we are professionals," they wrote (AJR, April 2013, Vol. 200:4, pp. 729-731).

"Who" is about identity. Radiologists have one, as doctors who wear white coats, carry stethoscopes, and sign their names with a rank in the professional hierarchy. When radiologists forget who they are, they can behave inappropriately, the team wrote.

In their article, the authors came up with a handful of anecdotes that illustrate what happens when radiologists forget who they are and what they're trying to do. All of the stories are true, but they didn't necessarily take place at their institution, Gunderman said.

Radiology gone wrong

There was, for example, the case of the interventional radiologist who prattled on and on about an overweight patient who was sedated and lying on the table for a procedure -- about her size, about the smell of her body; pretty awful stuff, Gunderman recalled in an interview with AuntMinnie.com.

"First, the patient overheard what was said and her feelings were hurt, and second, we should probably refrain from talking about patients in those terms at any time," Gunderman said. "It betrays a fundamental lack of respect for the patients as human beings with their own dignity. We need to avoid doing anything that would contribute to a culture of disrespect."

Departments can help by instituting programs that define nonthreatening communications, the authors noted.

The question goes to what radiologists are, and the answer is that they are many things: interpreters of images, teachers, administrators, and caregivers, Gunderman and Steiman wrote. It's important to remember all of the roles that contribute to the smooth functioning of a medical facility.

One radiologist stopped smooth functioning in its tracks -- responding in a perfunctory and demeaning manner whenever referring physicians asked him questions, Gunderman said.

"If they want our opinion, they should check the report," the radiologist said. "Otherwise, they should leave us alone so we can get the work done."

"As radiologists, we're called on to perform different functions at different times, and we need to be mindful of what our responsibilities are at a particular time," Gunderman said. "If we forget what's needed and what's appropriate to the situation, it can not only be bad for our patients, but bad for us as well."

Gunderman also described an individual who dealt with colleagues strictly on the basis of rank -- respectful of higher-ups, but dismissive of anyone lower in the hierarchy.

"He found it easy to treat people kind of dismissively when they're low on the ladder, but it gets very awkward when those people rise to a higher position on the ladder," he said. "The point is you hope we treat our colleagues -- whether they're above or below us in seniority -- as people, and as valued members of the team."

Of course, it's not always easy to be personable every time and in every way, but radiologists should always remember they're part of a larger whole, the authors wrote.

"When" is also an important question, and it's an important part of the problem regarding the radiologist who took a lengthy call from a financial advisor while consulting with a patient.

"This is what I think most of us would regard as an undesirable and inappropriate set of priorities," Gunderman said. "When we're with patients, we should do our best to focus on and make sure we're taking care of patients. If an emergency comes up, we would hopefully excuse ourselves and take care of it in private."

The radiologist's long, animated call about his financial portfolio didn't occur in the middle of an interventional procedure, only a consult. The patient wasn't at risk but did feel slighted by the situation, Gunderman said.

Another anecdote told of a radiologist who was very skilled but brusque with colleagues. His demeanor was cold and uncaring, though he had never been verbally abusive or violated policy. People who worked with him said he "acts like a machine" and interacts with others as if he were executing a set of computer commands rather than talking to people, the authors wrote.

"Let's face it -- some people are warmer, more personable, and more interested in relationships than others," Gunderman said.

But in any situation, treating people like component parts, whether they are patients or colleagues, "is going to undermine the quality of the relationships we build," he said. "That, in turn, may adversely affect care, undermine a good doctor-patient relationship, and undermine camaraderie with colleagues."

In general, good motives can help a lot. A doctor may unwittingly say the wrong thing to a patient or colleague, but do so in such a compassionate way that no one feels offended by it. Conversely, saying the same thing in a grudging or resentful way can leave patients and colleagues feeling hurt, the authors wrote.

Why radiologists do what they do is another important question, according to Gunderman and Steiman.

One radiologist, for example, had always done well at school and at work but was driven by competitiveness that undermined his effectiveness. The authors described the individual as seeing his life as a contest "in which there can be many losers but only one winner" -- and he did everything he could to ensure that he was a winner. From report turnaround times to patient satisfaction scores, the radiologist made sure he was outperforming his colleagues.

"There is an important difference between pursuing excellence and defeating others," the authors wrote. "The purpose of being a physician is not to make losers of our colleagues but to provide the best care we can to patients, to educate future health professionals, and to advance knowledge and practice in the field."

Knowing what is most worth our effort requires understanding why we are doing it, and connecting with the best reasons for our actions, they wrote.

Being sincere is another key to better relationships and being a better physician, according to Gunderman and Steiman.

"For example, are we disclosing errors because we are told we must, or out of respect for the dignity of the patient?" they wrote. "If we enhance our respect and compassion for others, such sentiments are likely to shine through in most everything we do."

But wait a minute, didn't radiologists -- at least some of them -- enter the profession so they could work alone in dark rooms, generally minimizing their contact with others throughout the workday?

"That could be, but if we've populated our field with people who really don't care to be around other people, then the outlook for our field is, I think, rather bleak," Gunderman said. "On the other hand, if radiologists really want to build relationships so that we can provide the best care we can, the outlook may be considerably brighter."

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