2 wks into my rad elective and ready to shoot myself

[LongIslProdigy]

My first few days of radiology I was like wow this is a pretty sweet gig. 5 computer monitors, dictation software, pretty much come and go as you please. I could see myself doing this, few IR procedures here and there, set up a nice little office in my house, maybe open a imaging center, do a few days from home, yada yada yada.

By my second week, Idk if I can make it until the end of this rotation. I feel like nothing is ever certain, just basically making a best guess for 95% of all images. As I sit with the resident and attending most read out's go like this:

Pt presented with RLQ pain, n/v, etc. Non-contrast CT abd/pelv.

Resident: Well, I didn't really see much. I thought this was the appendix. Maybe this. Well if this is the appendix, this could be some air, so I said its normal.

Attending: Hmm, well i'm not sure. That would be a slightly abnormal but not completely out of the ordinary position for the appendix. Do we see any fat-stranding.

Resident: Well I couldn't really see any fat-stranding. Maybe a little here, maybe a little there. But also look at this cyst on the L kidney.

Attending: Let's just stick to what the pt came in for. Looks like a simple cyst, if you want to call it, go ahead. I wouldn't make any big deal about it. So nothing else?

Resident: Nope, ok next case.

Now do this 50-75x during morning readout!! Ahhhhhh!!!!!

And DVT LE DOPPLER!!! "And here we have the vein when it's compressed and here it's not compressed. Wa La, no DVT"

Abdominal Ultrasound: "Hmm let's take a look at the tech's note to see what she thought"

I understand, if you're into anatomy, physics, want a pretty chill lifestyle!! And maybe it's different when you're the one in charge of dictating each case. But 5 years of residency, and a fellowship! Just to read head CT's/MR's, or body imaging, etc and that's it!

But please, any radiology residents! Show me the light!! I want to be interested, I really do!!!

---

Members don't see this ad.

 

[sexyman]

Sorry cant relate...at both programs I have rotated through the attendings and residents were brilliant- most cases certainly didnt seem ambiguous.

 

[colbgw02]

Cool story, Hansel.

 

[sexyman]

lol

 

[2012mdc]

Sorry cant relate...at both programs I have rotated through the attendings and residents were brilliant- most cases certainly didnt seem ambiguous.

I agree.

And although a lot of it was over my head (especially MR) I learned a good bit and the residents/attendings were good at teaching when they had time. I know DR rotations aren't known to be particularly engaging but maybe I got lucky as it really confirmed my specialty choice

 

[fun8stuff]

My first few days of radiology I was like wow this is a pretty sweet gig. 5 computer monitors, dictation software, pretty much come and go as you please. I could see myself doing this, few IR procedures here and there, set up a nice little office in my house, maybe open a imaging center, do a few days from home, yada yada yada.

By my second week, Idk if I can make it until the end of this rotation. I feel like nothing is ever certain, just basically making a best guess for 95% of all images. As I sit with the resident and attending most read out's go like this:

Pt presented with RLQ pain, n/v, etc. Non-contrast CT abd/pelv.

Resident: Well, I didn't really see much. I thought this was the appendix. Maybe this. Well if this is the appendix, this could be some air, so I said its normal.

Attending: Hmm, well i'm not sure. That would be a slightly abnormal but not completely out of the ordinary position for the appendix. Do we see any fat-stranding.

Resident: Well I couldn't really see any fat-stranding. Maybe a little here, maybe a little there. But also look at this cyst on the L kidney.

Attending: Let's just stick to what the pt came in for. Looks like a simple cyst, if you want to call it, go ahead. I wouldn't make any big deal about it. So nothing else?

Resident: Nope, ok next case.

Now do this 50-75x during morning readout!! Ahhhhhh!!!!!

And DVT LE DOPPLER!!! "And here we have the vein when it's compressed and here it's not compressed. Wa La, no DVT"

Abdominal Ultrasound: "Hmm let's take a look at the tech's note to see what she thought"

I understand, if you're into anatomy, physics, want a pretty chill lifestyle!! And maybe it's different when you're the one in charge of dictating each case. But 5 years of residency, and a fellowship! Just to read head CT's/MR's, or body imaging, etc and that's it!

But please, any radiology residents! Show me the light!! I want to be interested, I really do!!!

What year are you? After a handful of clinical rotations, you should realize that there is a lot of uncertainty in medicine. There are still areas of gray in radiology, hence the differentials. However, there are a number of bogus exams ordered and limited histories & physical exams performed/provided.... but actually being able to visualize the disease is a little more objective than pushing on someone's stomach and listening to their back (and then frantically scribbling: soft, NT/ND, BS+, no organomegally, CTA-B, RRR, no m/r/r, etc). Objective noninvasive diagnosis is the future of medicine and this falls in the realm of radiology.

 

[officedepot]

that rotation sounds 100x better than any medicine, surgery, psych, or obgyn rotation. I was interested just reading what you wrote.

anyway gotta decide if the work type is what interests you. Maybe you don't have the best residents. Not sure. But the filed isn't 100% exact but it's pretty close. The point of imaging is to always give a 100% diagnosis but it normally comes pretty close to giving a very accurate small differential if something is there. You also need to take into account that there are tons of imaging that probably isn't necessary and also a lot of imaging that is ordered as rule out issues. Regardless even if the indication is "rule out kidney stones" you, as a radiologist, are still responsible for calling that ovarian tumor and hepatic cyst.

so again see if the work interests you. If you can see yourself doing that. If not then pick something else.

 

[PokerDoc]

Sounds more fun than doing papsmears all day

 

[penguinophile]

It is also TOTALLY different actually driving and dictating. I came into med school wanting to do radiology, but sitting behind 2 people discussing the case make me incredibly tired. Radiology is a great job, and when appropriate tests are ordered the answers are often there. If you are at all interested, I'm sure plenty of your residents can speak to how awesome the field is.

 

[2012mdc]

It is also TOTALLY different actually driving and dictating. I came into med school wanting to do radiology, but sitting behind 2 people discussing the case make me incredibly tired. Radiology is a great job, and when appropriate tests are ordered the answers are often there. If you are at all interested, I'm sure plenty of your residents can speak to how awesome the field is.

I definitely had a lot of fun when the residents/attendings had extra time and let me drive and told me to describe what I saw/found.

 

[MedManU]

I'm not going to lie, I was bored during my radiology rotation. It's not fun watching other people do everything. I just tried to put myself in their shoes and realized that I would really enjoy actually doing it. Good analogy I heard - "I loved playing Golden Eye on N 64, but I never liked watching my friends play it."

 

[officedepot]

I'm not going to lie, I was bored during my radiology rotation. It's not fun watching other people do everything. I just tried to put myself in their shoes and realized that I would really enjoy actually doing it. Good analogy I heard - "I loved playing Golden Eye on N 64, but I never liked watching my friends play it."

so true. On these lines, OP, ask for a case if they have time and if you want one. Just ask to get practice. I'm sure you've done this before but on other rotations pull up the imaging test on a patient and come up with your own interpretation before looking at the radiologist's read. More fun that way to test yourself at this point.

 

[DrBowtie]

I definitely had a lot of fun when the residents/attendings had extra time and let me drive and told me to describe what I saw/found.

I'm not going to lie, I was bored during my radiology rotation. It's not fun watching other people do everything. I just tried to put myself in their shoes and realized that I would really enjoy actually doing it. Good analogy I heard - "I loved playing Golden Eye on N 64, but I never liked watching my friends play it."

so true. On these lines, OP, ask for a case if they have time and if you want one. Just ask to get practice. I'm sure you've done this before but on other rotations pull up the imaging test on a patient and come up with your own interpretation before looking at the radiologist's read. More fun that way to test yourself at this point.

x1000. When you are passive to the situation, its boring. You think you see something and the person driving blows through it 3 or 4 times before you can even orient yourself.

I had an absolute blast of the days that I was able to "sign out" cases with an attending.

 

[2012mdc]

so true. On these lines, OP, ask for a case if they have time and if you want one. Just ask to get practice. I'm sure you've done this before but on other rotations pull up the imaging test on a patient and come up with your own interpretation before looking at the radiologist's read. More fun that way to test yourself at this point.

I knew radiology was for me when I spent more time looking at images than writing progress notes and H&P's. It also taught me how challenging yet interesting residency will be.

 

[Jack is Back]

I'm curious about radiology as a specialty, it's been an outlier for me. I'm just curious how this field will sustain itself in the next 30 years.

I'm not trying to troll here either.

How do American radiologists compete with international radiologists who will work for less? With technology now, can't they just send images across the world and read them for 1/2 the price?

What is the advantage of using American docs? Does the radiologist really need to be on site (what's the advantage of an on site radiology service) or will they just all eventually be outsourced to huge groups?

Sorry, I'm just ignorant about this field. Thanks for the responses in advance!

 

[michaelrack]

How do American radiologists compete with international radiologists who will work for less? With technology now, can't they just send images across the world and read them for 1/2 the price?

!

international radiologists typically don't have a medical license for the state in which the radiological procedure is being performed. Also, docs ordering a rad test like it if there is a local radiologist available to discuss the results, if necessary

disclaimer: I am not a radiologist

 

[fun8stuff]

I'm curious about radiology as a specialty, it's been an outlier for me. I'm just curious how this field will sustain itself in the next 30 years.

I'm not trying to troll here either.

How do American radiologists compete with international radiologists who will work for less? With technology now, can't they just send images across the world and read them for 1/2 the price?

What is the advantage of using American docs? Does the radiologist really need to be on site (what's the advantage of an on site radiology service) or will they just all eventually be outsourced to huge groups?

Sorry, I'm just ignorant about this field. Thanks for the responses in advance!

Any doctor practicing in the US must have a license in the state where they practice. Not surprisingly, it's no different for radiologists and it won't be any time soon. Even if for some reason the US people and malpractice decided it would be okay for any old foreign person to practice in the US without a license, the majority of the world's radiologists live in the US. There are far fewer radiologists overseas and in places like India than there are here. However, teleradiology exists because most radiologists do not like working nights and weekends, although this is changing and a lot of hospitals are requiring radiology to have a presence at the hospital 24/7 (although the supply is currently too low for this to be possible in the rural areas).

How will radiology sustain itself? It's at the forefront of medicine and will continue to expand with technology. The 'physical exam' is dead. It's too subjective most of the time. Today, "primary care" and ER docs learn how and what kind of test to order rather than the intricacies of the physical exam. NPs and PAs can do a lot of this work. The future of medicine is the objective, noninvasive diagnosis and minimally invasive treatment of disease. Radiology will play a large role in both these areas.

There will continue to be onsite radiologists. Not just for problem/stat cases and imaged-guided procedures, but also in protocoling the proper exam. Over the last 20 years, radiology has grown significantly because as technology has gotten better, clinicians order multiple radiology exams on every patient. Although this has been good for the radiologists wallets, health expenditure is out of control. Half the time, clinicians do not know the proper test to order or the correct indications. They just know there is abdominal pain and they want a CT abdomen.. with/without contrast? dual phase? triple phase? renal stone? pancresa protocol? CTA? with runoff? tagged RBC scan? HIDA scan? abdominal US? mebrofenin? mag-3? Radiologists are only ones of understand this and will eventually become the gatekeepers and in charge of quality control making sure exams are high-quality and low-dose radiation.

 

[officedepot]

^^^^ exactly. fun8stuff wrote a fantastic post!

to add my take: if anything radiology is expanding and will play even larger roles in patient care. Hospitals are requiring onsite radiology because it is far more reliable, especially for getting stat reads and quick consults. Furthermore image guided medicine is expanding in all different kinds of ways. I don't see radiologists in the future ceding this stuff to other docs like they have done in the past.

 

[Jack is Back]

Any doctor practicing in the US must have a license in the state where they practice. Not surprisingly, it's no different for radiologists and it won't be any time soon. Even if for some reason the US people and malpractice decided it would be okay for any old foreign person to practice in the US without a license, the majority of the world's radiologists live in the US. There are far fewer radiologists overseas and in places like India than there are here. However, teleradiology exists because most radiologists do not like working nights and weekends, although this is changing and a lot of hospitals are requiring radiology to have a presence at the hospital 24/7 (although the supply is currently too low for this to be possible in the rural areas).

How will radiology sustain itself? It's at the forefront of medicine and will continue to expand with technology. The 'physical exam' is dead. It's too subjective most of the time. Today, "primary care" and ER docs learn how and what kind of test to order rather than the intricacies of the physical exam. NPs and PAs can do a lot of this work. The future of medicine is the objective, noninvasive diagnosis and minimally invasive treatment of disease. Radiology will play a large role in both these areas.

There will continue to be onsite radiologists. Not just for problem/stat cases and imaged-guided procedures, but also in protocoling the proper exam. Over the last 20 years, radiology has grown significantly because as technology has gotten better, clinicians order multiple radiology exams on every patient. Although this has been good for the radiologists wallets, health expenditure is out of control. Half the time, clinicians do not know the proper test to order or the correct indications. They just know there is abdominal pain and they want a CT abdomen.. with/without contrast? dual phase? triple phase? renal stone? pancresa protocol? CTA? with runoff? tagged RBC scan? HIDA scan? abdominal US? mebrofenin? mag-3? Radiologists are only ones of understand this and will eventually become the gatekeepers and in charge of quality control making sure exams are high-quality and low-dose radiation.

Agreed with the idea that the physical exam is dying. I actual find it strange that they teach us now to palpate for this or that when we can order a scan that can say with 99% accuracy or higher what it is and how large it is.

Interesting points. I think technology makes rads an interesting field and it's definitely on my short list the more I learn about it.

 

[officedepot]

Agreed with the idea that the physical exam is dying. I actual find it strange that they teach us now to palpate for this or that when we can order a scan that can say with 99% accuracy or higher what it is and how large it is.

well you still gotta know when it is appropriate to order a scan. Yes if you feel something a scan is required most likely. If you feel nothing then perhaps not. You cannot just have every patient get a pan ct scan before seeing them before every visit. You don't get a mammogram on every single breast mass you feel depending on lots of different factors with the patient. Also, you aren't, for example, going to order daily cxrs on a patient with pneumonia. Yeah you get that first one but then generally follow them clinically based on how they feel and exam findings.

There are plenty of other examples where the exam is relevant. So the physical exam is dying in a way but it is still very important. I don't think fun8stuff was saying that it is pointless to do an exam. But it is more along the lines that in order to diagnose lots of things now a scan is required.

 

[colbgw02]

Teleradiology is reaching its zenith. Apart from the benefits of having a radiologist in the flesh available for review and consultation, reimbursements are going down. Therefore, it's becoming increasingly difficult for practices to either 1) absorb the cost of paying for a telerads preliminary read or 2) lose the professional fee to the teleradiologist for a final read. We're seeing more and more practices trying to hire people to work nights for a partnership track. Most people don't want to work nights, which is part of the reason why there will always be a market for teleradiology. However, the idea that telerads is the inevitable end point toward which radiology is moving is incorrect. The last ten years offered a perfect mix of better technology (e.g. PACS, highspeed internet), high work loads, and high reimbursement. The last one is going away, and the field is increasingly aware of the dangers of commoditization.

 

[Jack is Back]

well you still gotta know when it is appropriate to order a scan. Yes if you feel something a scan is required most likely. If you feel nothing then perhaps not. You cannot just have every patient get a pan ct scan before seeing them before every visit. You don't get a mammogram on every single breast mass you feel depending on lots of different factors with the patient. Also, you aren't, for example, going to order daily cxrs on a patient with pneumonia. Yeah you get that first one but then generally follow them clinically based on how they feel and exam findings.

There are plenty of other examples where the exam is relevant. So the physical exam is dying in a way but it is still very important. I don't think fun8stuff was saying that it is pointless to do an exam. But it is more along the lines that in order to diagnose lots of things now a scan is required.

So, I'm an M1 and trying to learn more about Rads as a field. Should I just do lots of roaming around SDN or do you guys recommend any sites or books?

 

[Enkidu]

My first few days of radiology I was like wow this is a pretty sweet gig. 5 computer monitors, dictation software, pretty much come and go as you please. I could see myself doing this, few IR procedures here and there, set up a nice little office in my house, maybe open a imaging center, do a few days from home, yada yada yada.

By my second week, Idk if I can make it until the end of this rotation. I feel like nothing is ever certain, just basically making a best guess for 95% of all images. As I sit with the resident and attending most read out's go like this:

Pt presented with RLQ pain, n/v, etc. Non-contrast CT abd/pelv.

Resident: Well, I didn't really see much. I thought this was the appendix. Maybe this. Well if this is the appendix, this could be some air, so I said its normal.

Attending: Hmm, well i'm not sure. That would be a slightly abnormal but not completely out of the ordinary position for the appendix. Do we see any fat-stranding.

Resident: Well I couldn't really see any fat-stranding. Maybe a little here, maybe a little there. But also look at this cyst on the L kidney.

Attending: Let's just stick to what the pt came in for. Looks like a simple cyst, if you want to call it, go ahead. I wouldn't make any big deal about it. So nothing else?

Resident: Nope, ok next case.

Now do this 50-75x during morning readout!! Ahhhhhh!!!!!

And DVT LE DOPPLER!!! "And here we have the vein when it's compressed and here it's not compressed. Wa La, no DVT"

Abdominal Ultrasound: "Hmm let's take a look at the tech's note to see what she thought"

I understand, if you're into anatomy, physics, want a pretty chill lifestyle!! And maybe it's different when you're the one in charge of dictating each case. But 5 years of residency, and a fellowship! Just to read head CT's/MR's, or body imaging, etc and that's it!

But please, any radiology residents! Show me the light!! I want to be interested, I really do!!!

If diagnostic certainty is what you are looking for, you may enjoy pathology more than radiology. I think that radiology is pretty similar to what you described, people trying to guide the clinicians as well as they can with limited information. Nothing against the field, but radiology provides clinicians with rapid information to form a differential diagnosis. Pathology gives them a definitive diagnosis, but not too rapidly. I think they're both pretty interesting in their own ways.

 

[penguinophile]

So, I'm an M1 and trying to learn more about Rads as a field. Should I just do lots of roaming around SDN or do you guys recommend any sites or books?

To Learn the material:
Learningradiology.com ctisus.com http://www.radiologyassistant.nl/en/ http://radiographics.rsna.org/ is also good if you have the patience.

To learn what the life is like, screw whatever we say, spend time with the residents at your hospital. As an M1 it seems like you have no time at all, but really you have more than enough to visit and see what life is like. Just remember, it will get cooler the more material you actually know.

 

[Hysty]

Not the correct way to practice medicine. Radiology is a great field but cannot and should not replace physical examination. Physicians who order unnecessary imaging/labs do not have good a good reputation and are not very good clinicians.

 

[yohimbine1]

My first few days of radiology I was like wow this is a pretty sweet gig. 5 computer monitors, dictation software, pretty much come and go as you please. I could see myself doing this, few IR procedures here and there, set up a nice little office in my house, maybe open a imaging center, do a few days from home, yada yada yada.

By my second week, Idk if I can make it until the end of this rotation. I feel like nothing is ever certain, just basically making a best guess for 95% of all images. As I sit with the resident and attending most read out's go like this:

Pt presented with RLQ pain, n/v, etc. Non-contrast CT abd/pelv.

Resident: Well, I didn't really see much. I thought this was the appendix. Maybe this. Well if this is the appendix, this could be some air, so I said its normal.

Attending: Hmm, well i'm not sure. That would be a slightly abnormal but not completely out of the ordinary position for the appendix. Do we see any fat-stranding.

Resident: Well I couldn't really see any fat-stranding. Maybe a little here, maybe a little there. But also look at this cyst on the L kidney.

Attending: Let's just stick to what the pt came in for. Looks like a simple cyst, if you want to call it, go ahead. I wouldn't make any big deal about it. So nothing else?

Resident: Nope, ok next case.

Now do this 50-75x during morning readout!! Ahhhhhh!!!!!

And DVT LE DOPPLER!!! "And here we have the vein when it's compressed and here it's not compressed. Wa La, no DVT"

Abdominal Ultrasound: "Hmm let's take a look at the tech's note to see what she thought"

I understand, if you're into anatomy, physics, want a pretty chill lifestyle!! And maybe it's different when you're the one in charge of dictating each case. But 5 years of residency, and a fellowship! Just to read head CT's/MR's, or body imaging, etc and that's it!

But please, any radiology residents! Show me the light!! I want to be interested, I really do!!!

rads is a bunch of guesswork and hedging. Some aunt minnies here and there.

Path involves guesswork now and then too. Can't escape it.

 

[ar2388]

even though my rads rotation included a lot of sitting behind residents and attendings while they looked through scans and dictating, I actually had a good time. Sometimes they were able to talk with me and teach me a couple of things, ask a few questions, etc, but even when all they were doing was scrolling up and down, I found it interesting to watch the image and try to figure out how they were approaching it (everyone is so different) and what they were looking at. i havent done too many rotations, but so far radiology has been my favorite. I was actually happy walking to the hospital every morning

 

[shark2000]

Medical student level: You love patient interaction, though it is not a true interaction. You see the patients briefly in the morning, chat with the patient and family and feel you are a doctor. You don't have to deal with the bad parts and BS. At the end of the day, you have a feeling of competency. Oh, and that discussion with the patient and his family was the most interesting thing today. On the other hand, at rads rotation you are very passive. You do not know the whole picture. Stuff are really complicated. It is boring. You feel incompetent.
Attending level: You dislike or hate seeing patients. They complain. Many are not reasonable. You do not care to be a doctor. The only important thing is to get the job done and go home. Always afraid of getting paged after leaving the hospital. Oh, and that CT abdomen was the most interesting thing you saw today. Otherwise, all was BS.