Too busy

[neusu]

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To preface, I am a neurosurgery resident, and the words "I am too busy" or "I am getting slammed, can it wait until morning" are not in my vocabulary.

I don't know if it's just my institution, or what I am requesting, but getting a read on overnight studies has become an issue. Be it a chest X-ray, CTA brain, or MRI w/ w/o contrast, I have had encounters with the rads resident on overnight and the previously qouted responses.

While I understand a lone resident at night is often inundated with trauma/emergent studies which obviously take priority, I am merely asking for a wet read, no documentation, so I can say on rounds I talked to overnight rads and this is what they said. Certainly, some studies such as CTA/MRI w/ w/o brain take a lot of time to interpret. That is what the day team is for. Nonetheless, how hard is it to be a gentleman/woman, take a look, give your impression?

/end rant

 

[elektroshok]

cool story bro

 

[elektroshok]

But in all seriousness,

Usually there is only 1-2 residents on call with a full list of stuff to get through at all times. It is too easy to miss stuff giving a 'wet read' and not going through it systematically like every other study is why I think a lot of people are hesitant about it.

Also, no one comes into your OR when you're in the middle of a case and asks you to stop what you're doing to come see a consult RIGHT now.

Obviously a little different, but the concept is the same.

 

[ijn]

To preface, I am a neurosurgery resident, and the words "I am too busy" or "I am getting slammed, can it wait until morning" are not in my vocabulary.

I don't know if it's just my institution, or what I am requesting, but getting a read on overnight studies has become an issue. Be it a chest X-ray, CTA brain, or MRI w/ w/o contrast, I have had encounters with the rads resident on overnight and the previously qouted responses.

While I understand a lone resident at night is often inundated with trauma/emergent studies which obviously take priority, I am merely asking for a wet read, no documentation, so I can say on rounds I talked to overnight rads and this is what they said. Certainly, some studies such as CTA/MRI w/ w/o brain take a lot of time to interpret. That is what the day team is for. Nonetheless, how hard is it to be a gentleman/woman, take a look, give your impression?

/end rant

it's called ROADS for a reason brah. lifestyle > *

it can wait until morning

 

[colbgw02]

elektroshok is right. show me a resident/radiology who's providing wet reads to needy resident/neurosurgeon on complex cases, and i'll show you a someone who's missing things. you know what's more annoying than not being able to put that i-talked-to-the-on-call-radiology-resident feather in your cap on rounds? the phone call 5 hours later about the subtle dissection that wasn't seen on the wet read.

we have to triage too. sometimes, that triage is forced onto us by hospital admin, and that usually prioritizes the ED before inpatients before everything else. trust that the on-call radiologists isn't sitting on his hands when he says he'll get to it later. we delivered medical care for a really long time without immediate reads on overnight inpatient MRs, so trust me when i say that - generally speaking - you can wait a few hours.

 

[colbgw02]

it's called ROADS for a reason brah. lifestyle > *

it can wait until morning

not sure if being facetious, but radiology residency is still a lifestyle specialty when the sun is up. on-call during residency is typically not, and private practice radiology hasn't been a lifestyle specialty for awhile. the ROAD specialties were so named because they had a good lifestyle-to-pay ratio. The pay is largely still there, but that's come at the expense of lifestyle.

EDIT: apparently putting lifestyle : pay (sans spaces) gives an emoticon.

 

[bricktamland]

I am merely asking for a wet read so I can say on rounds I talked to overnight rads and this is what they said.

Read that sentance again. Comes off rather egotistical to me.

Reminds me of a time when I was a radiology resident and an overly ambitious general surgery resident was demanding an upper GI study in the middle of the night for a 16 yo inpatient with 5 years of occassional vomiting. She wanted to rule out an undiagnosed malrotation. I was getting slammed by the ER at the time. So I asked her about her patient's current status, was she currently vomiting or in any abdominal pain? "No she's asleep." OK, so why do you need this right now, at 3 AM? "Well, I want to have the patient lined up so we can fit her in for surgery in the morning." I said, well, I'm very busy right now and I don't see that an urgent upper GI study is indicated. In fact, for a 16 year old, I would instead recommend a CT abdomen/pelvis, as there is a much broader differential for the symptoms you describe beyond the rare delayed presentation of malrotation, plus, as an added bonus, we can also rule out malrotation with the CT. She became furious and said, "why would I get a CT for malrotation when upper GI is the gold standard!?!?!?!" I said, well maybe in infants it's the gold standard, but for a 16 year-old, I would get the CT. She was so incensed that she just fumed, "so you're not going to do the upper GI?" I said, no, you can get a CT or wait for the day team to do the upper GI. Before storming out of the reading room, she assured me she would report me to her staff in the morning. I said fine, do what you feel is necessary. Well, she ended up getting chewed out by her staff. And, they ordered a CT.

The morale of the story is that your desire to shine like a superstar during morning rounds by looking all teed up does not take precedence over acute ER and inpatient studies. If you have a case that needs a stat read because you will take immediate action on it, well that's one thing. But interrupting the care of other patients for your own selfish benefit is another.

Furthermore, asking for a quick "wet read" can be downright dangerous. Too many times when I was a resident on call I tried to be the nice guy and quickly look through a study so I could accomodate a request for a wet read. Besides being a major disruption in work flow, circumventing the appropriate systematic approach leads to errors, potentially catastrophic errors if that inaccurate interpretation is then acted upon.

Perhaps if you're nice and not demanding, and establish a nice rapport with your radiology resident colleagues, they might find some downtime in which they can help you out at night.

 

[shark2000]

To preface, I am a neurosurgery resident, and the words "I am too busy" or "I am getting slammed, can it wait until morning" are not in my vocabulary.

I don't know if it's just my institution, or what I am requesting, but getting a read on overnight studies has become an issue. Be it a chest X-ray, CTA brain, or MRI w/ w/o contrast, I have had encounters with the rads resident on overnight and the previously qouted responses.

While I understand a lone resident at night is often inundated with trauma/emergent studies which obviously take priority, I am merely asking for a wet read, no documentation, so I can say on rounds I talked to overnight rads and this is what they said. Certainly, some studies such as CTA/MRI w/ w/o brain take a lot of time to interpret. That is what the day team is for. Nonetheless, how hard is it to be a gentleman/woman, take a look, give your impression?

/end rant

When it is very busy and I have tons of studies on my list, there are very few critical findings that I look at on every study before getting to that study. For example, I look at DWI on all brain MRs if I plan to read them in half an hour. Or I look at all trauma cases for Pneumo, Dens fracture or active bleeding/aortic injury before getting to them. Otherwise, I never look at a study, unless I want to FINAL READ it.

Except for Xrays, I never ever give "wet read" over phone. If they have a very very specific question on cross sectional imaging and it is critical (like aortic dissection or pneumo), I may look at it .

My experience is the same as the other radiologists here. You miss big time when you look at the studies in a short time over phone.

I usually ask them their contact number and then call them back. I try to put the study next on my list. If I am jammed with ED studies, I tell them that it may take a while or an hour or so.

For example, last week I was on call. I got a CTA chest from ICU to rule out PE. 2 minutes after the study was done, someone called me for a wet read. I told them that I will call them in 20 minutes. She was arguing that this is a super emergent finding. Later when I checked, the patient was hemodynamically stable and was already on heparin. What is changed by this 20 minutes or half an hour?

On the other hand, I agree with you. I personally expect a read on an inpatient study within 3-4 hours. If it is something like stroke, probably within half an hour.

 

[DrBowtie]

The concept of a search pattern is lost on those outside the field.

 

[neusu]

Thanks for the explanations. To clarify, most of the folks overnight are very helpful and unless it truly is urgent I'm more than happy to get a page or call back when they get around to the study in question. Perhaps it is just a couple of individuals who seemingly always are too busy or getting slammed. I can understand the hesitancy for giving a wet read and typically I am asking to confirm or refute my interpretation of the study or if there is anything obvious.

 

[colbgw02]

Thanks for the explanations. To clarify, most of the folks overnight are very helpful and unless it truly is urgent I'm more than happy to get a page or call back when they get around to the study in question. Perhaps it is just a couple of individuals who seemingly always are too busy or getting slammed. I can understand the hesitancy for giving a wet read and typically I am asking to confirm or refute my interpretation of the study or if there is anything obvious.

Have you correlated these experiences with the training level of the radiology residents? Apart from individual variance, there will be a world's of difference between an R4 and an R2, who is relatively new to call.

 

[fun8stuff]

To preface, I am a neurosurgery resident, and the words "I am too busy" or "I am getting slammed, can it wait until morning" are not in my vocabulary.

I don't know if it's just my institution, or what I am requesting, but getting a read on overnight studies has become an issue. Be it a chest X-ray, CTA brain, or MRI w/ w/o contrast, I have had encounters with the rads resident on overnight and the previously qouted responses.

While I understand a lone resident at night is often inundated with trauma/emergent studies which obviously take priority, I am merely asking for a wet read, no documentation, so I can say on rounds I talked to overnight rads and this is what they said. Certainly, some studies such as CTA/MRI w/ w/o brain take a lot of time to interpret. That is what the day team is for. Nonetheless, how hard is it to be a gentleman/woman, take a look, give your impression?

/end rant

How many surgeries can you do at once? How many patients can you assess all at once? I'm guessing not much more than 1. When we're on call there is always a long list of STAT cases to do that everyone wants done ASAP ...AND... there are people like you who call us constantly who want us to stop what we're doing and give them a wet read. You'd be pissed too if someone interrupted you every 30 seconds while you were in surgery or seing another patient... there is a limit to how much we can do at one time.