Random in Radiology

Image via Parmahospital.org.

This is it… I am ¼ of the way through my final clerkship rotation.  And this rotation is… Radiology.  Yes!!

I chose this on purpose.   It is ridiculously relevant to my future career in Radiation Oncology.   And, to be honest, I heard that radiology selective is fairly laid back and provides ample time to study.

So far, it has been eventful in ways I could not have anticipated…

I somehow scammed a day off for the St. Patrick’s Day holiday (only here would people actually take the Monday after St. Patrick’s Day weekend as a holiday… Well, maybe Ireland too… But it is not really a legitimate holiday for 95% of the population here, just high up government people and apparently university administration).  I did not just not show up or something… I literally went in, ready to go.  And the residents told me it was a university holiday.  I told them it wasn’t for clerks.  They told me to go home anyway, nobody would care.  I considered arguing, but then my laziness smarter side got ahold of me and I agreed and went back home.

I had a post-Match career crisis.  But, it was not an “oh my goodness should I pursue radiology” crisis (because I really don’t love radiology).  It was a “oh my gosh, I love peds, what am I going to do without it” kind of crisis.  Weird.  I loved my Pediatrics rotation.  Loved.  I still knew it wasn’t my career goal… Palliative Medicine, Oncology… Those were mine.  But, I was doing pediatric radiology yesterday and I loved hearing the little voices and helping pin down little once for certain tests (nicely, but pin nonetheless).  I think that my love of peds is more my want for children of my own and less my actual love of pediatrics as a specialty.  The most satisfying option still seems to be adult rad onc, probably palliative, but who knows… Maybe I will throw a few kids in the mix.  But wow, not the brief and short-lived second thoughts I would not normally anticipate.

Despite people all saying that you can generally leave at lunch to do independent study and work on our required case presentations, I have somehow managed to get trapped until 4 every day.  Why am I so keen?  And nice?  WHY?

Today, the power went out.  In the ENTIRE hospital.  And back-up emergency power did not kick in right away.  In fact, it took a whole 30-ish seconds.  Which doesn’t sound so bad, except I was in the basement with no windows.  Freaky.  It took about 20 minutes before real power was restored to the building.  The sad part is that this isn’t the first time that has happened here.  I just sat in my corner and did practice LMCC questions on my phone.  Mainly because I couldn’t leave the office… Because it was too dark.

Radiology

Image via Wikipedia

Radiology is a ridiculously busy department.  I always felt guilty when I needed to go down to beg ask for a scan from one of the staff radiologists because I always seemed to be annoying inconveniencing them.  Turns out, I was kind of right.  The sheer volume of people coming in and asking for scans to be done on inpatients or urgent outpatients is ridiculous (one might argue that this could be solved by changing the way in which scans are prioritized and ordered, but apparently that isn’t an option).  It is so tough to get work done with all of those ins and outs and people calling looking for results.

The thing is that we depend so much on radiology.  When we don’t know what is happening.  When we do know what is happening.  Patients ask for scans because they want to know what is happening.  Honestly, we are keeping the radiologists busy with a lot of normal scans.  And we are exposing people to unnecessary radiation and stress and spending government money.  I am not saying that we stop all of our scans.  But, I think, as physicians, we need to think more about what and why we are ordering things.  We did learn how to do histories and physicals for four years for a reason.  And it wasn’t to order a CT of everything and hope for the best.  We need to ask ourselves what the scan will change or prove or disprove that we can’t determine in another way?  We need to ask if it is standard of care or something ridiculous?

Trust me, when the power goes out… Radiology is not really there for you.  They just sit and drink coffee and wait for the lights to come back on.  But, you can still do histories and physicals.  You still have some clinical judgment.

Mind you, radiology is SO valuable.  You can find early tumors, follow pregnancies closely to prevent undue complications, treat certain illnesses. Overall, it is something that enhances patient care.  Overall, it is worth taking the time and strain to go beg for a test and it is worth the radiologist’s time to listen.  But, we still abuse the system far too often.

So, I think this rotation is a good wrap up of clerkship.  I am learning the art of waiting (for people to review with me, for images to become available).  I am gaining valuable skills in reading images.  And I think that listening to what goes on the department will give me a better idea of how to more appropriately use the technology we are so fortunate to have.

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12 thoughts on “Random in Radiology

  1. My youngest son is still an undergraduate but busy taking all of his pre-med coursework. His heart’s desire is to be a physician someday. Your post made me think of him as he is currently working an (unpaid) internship at a hospital near his university. His current assignment is helping out in the emergency room/radiology department. He is loving this rotation.

    You bring up lots of interesting points regarding how hospital tests can be over used. I don’t know what the answer is to that problem either, but I do suspect that there could be a further “narrowing down” of symptoms that might weed out who really needs a scan and who doesn’t.

    Interesting post.
    God bless you as you pursue your calling!

    • Good for him! I studied nuclear medicine in my undergrad and spent a great deal of unpaid time in a hospital radiology department too… It will totally pay off for him! I will be praying for him as he goes through the journey to medicine… Such a busy and exciting time of preparation even in undergrad!

      I am glad I got you thinking a bit. There definitely could be some further “narrowing down” of symptoms… Its a time thing and a big problem… But one day maybe we will sort it out.

      Thanks for reading! Blessings!

  2. I have two fine friends and one really great relative that work in radiology. Very interesting. I’ve never thought about what would happen if you needed an x-ray and the power shut down. It would really suck if you were right in the middle of having one done! Sandy

  3. Having had more xrays than I would like for multiple orthopedic issues I have developed a huge appreciation for the radiology department! I still have a desktop image of a scan that nicely shows my extended Stryker!

  4. Sadly, there will be pediatrics in your radiation oncology career. We pediatric anesthesiologists make almost daily trips throughout the year with little ones going over to the adult site for their treatment. It will be a wonderful thing for them and their families that you love children!

    • Its true. I hope that I will get to be one of the people treating those little ones who unfortunately have to deal with that… It depends a lot on the hospital I wind up in whether or not I get to see many or limited pads cases (a few hospitals around here refer all of the kids out to a bigger centre with a paediatrics hospital attached for treatment).

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