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Case worries- problem to address?
Do most of you turn off once you leave work until the next time your back. Anyone have worries about cases and look again later at home to make sure? Or stay later in a shift to check your work? When would you say this is a problem and not just concern for your patients and work?
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34 Replies
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Usually turn off
Harder after a busy call shift. Sometimes Ill confirm I mentioned something hours later at home on a call day
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I think it’s normal to have 1 or 2 cases that may stick in your head at the end of the day. Otherwise, I try to “switch off” for my own sanity.
The question of “is it a problem” kind of depends on where you’re at in your career. Making a guess that OP may be early on … if so, then time and experience will help set your confidence level.-
I did this almost daily in first couple of years in practice. Now, much less so. But still have the occasional instance of this once every couple of weeks.
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I save most interesting questions or ones that I have made follow-up recommendation on into a PACS teaching file. I’ll bounce back to them intermittently until I can confirm the diagnosis or that the team managed the case appropriately.
No reason to do that from home after-hours though.
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How about if your mid career and worries happen fairly regularly? Causes disruption and wastes time? Usually checks are ok but rare addendums or having to call in extra findings happen.
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Even so, you said it yourself “usually check are ok but rare addendums …” If you’ve been burned on a case before that will absolutely make you look a few extra times at a case before signing off. That being said, it sounds like you have good insight into what your trends are. Focusing on that may provide some respite.
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When does this cross over to OCD?
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Its harmless to talk to a counselor about it. I would find someone you trust that is qualified and that understands radiology workflow and talk with someone about it.
Your repeated questions despite reassurances from the posters above shows its probably a bigger issue that you should be proactive about now.
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I sometimes go back on things like brain tumors after I had time to think about it and look up some references. If it’s Saturday evening and I have a queue with motorcycle traumas building, the new presentation brain tumor may get a nonspecific interpretation. Sunday afternoon after it bugs me for a while l get back to it and give a more specific list of differentials. Given that the decision making on most of these takes a few days, there is no reason not to do it that way.
I also try get back to the traumagrams after things calm down, re-count the ribs and pick up the minor stuff that may not have made it into the initial report.
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Quote from Bdr123
When does this cross over to OCD?
Radiologists have to have some degree of OCD to function properly. It’s just part of the job. Ruminating about a difficult case (or one that didn’t seem difficult initially) is part OCD, part being a caring physician.
But if you find the thoughts becoming intrusive, interrupting your sleep or leisure time to any significant extent, then it might be time to talk to someone about it. Your senior partners might or might not be sympathetic; it might be best to seek some outside counseling as was said above. -
Quote from Bdr123
When does this cross over to OCD?
When you start asking anonymous people on a message board? 😉
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Quote from Bdr123
Do most of you turn off once you leave work until the next time your back. Anyone have worries about cases and look again later at home to make sure? Or stay later in a shift to check your work? When would you say this is a problem and not just concern for your patients and work?
My opinion is that obsessing/perseverating over your previous day’s reads is a problem if it’s interfering with your ability to live your non-work life.
I keep a small notebook where I jot down interesting/puzzling cases and every month go back and follow them up. In addition to being very educational and (I’d like to think) improving my skills, putting the cases in my notebook allows me to “forget” about them for a whiile. Every month, there’s about 10-20 cases I go through. It’s not much but having done it since residency, it’s been close to 30 years so the sediment layer in my brain is pretty substantial by this point.
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Therapy may be an option. Do you guys think taking an SSRI is going too far because of work? That also opens up more issues with credentialing, etc.
Part time or switching to a less demanding job like VA may be better? Problem is worse after demanding call shifts and long stretches without days off, like call weekend weeks.
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I’d avoid taking SSRIs unless it’s causing significant loss of sleep, anxiety, burnout, etc. It’s not really a big deal medically, but from a licensing/credentialing standpoint it may cause issues.
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Quote from Xtatero
I’d avoid taking SSRIs unless it’s causing significant loss of sleep, anxiety, burnout, etc. It’s not really a big deal medically, but from a licensing/credentialing standpoint it may cause issues. [/style]
[style=”background-color: #ffffff;”]I’ve been on credentialing committees and have never heard of this remotely as an issue. I believe this is clearly misinformation; the downside of believing anything on a forum without independently verifying. [/style]
[style=”background-color: #ffffff;”] So many people are on SSRI’s, it’s like a vitamin. [/style]
[style=”background-color: #ffffff;”] If you need such medication, after appropriate evaluation and prescribing, I don’t think it is an issue at all. [/style]-
Psychiatric treatment is not an issue from a credentialing and licensing aspect. Having a mental disorder that affects ones ability to safely perform as a physician is the only question ever asked.
It IS however an issue if you ever wanted a pilot’s license. The FAA medical division is in the stone age.
The reason not to take SSRIs would be the potential side effects. Unless you had serious OCD that affects your ability to do your job or function in your daily life. Logging in and checking on a case you read or thinking about your patients outside of work doesn’t sound like that level of impairment.
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Quote from Bdr123
Therapy may be an option. Do you guys think taking an SSRI is going too far because of work? That also opens up more issues with credentialing, etc.
Part time or switching to a less demanding job like VA may be better? Problem is worse after demanding call shifts and long stretches without days off, like call weekend weeks.
I HOPE it goes without saying that you should [i]only[/i] take SSRI’s or any other such drug under the direction of a physician trained to administer and monitor this therapy. I suspect you aren’t at the level of distress that would require this. Since we’re all anonymous here, may I ask if there are other things going on in your life that are contributing to your unease?-
SSRIs are pretty nasty meds. Personally never taken one but know people who do and all have gained massive amount of weight. I don’t think we really have a clue how these meds work. The interplay of the various neurotransmitters at the synapses in the brain is likely extremely complex and is poorly understood.
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Quote from Waduh Dong
SSRIs are pretty nasty meds. Personally never taken one but know people who do and all have gained massive amount of weight. I don’t think we really have a clue how these meds work. The interplay of the various neurotransmitters at the synapses in the brain is likely extremely complex and is poorly understood.
That’s correct. The theory also about serotonin has been known to be wrong since the Lancet article (and the correction, though that was dismissed) in the 1970s. At that point pharma had a stronghold and the “standard of care” was set. I know it’s not serotonin, which just dulls you out, because sleep and motivation is based on dopamine. Depression and bipolar are dopamine issues, though of course there is a ton at play with balance, turnover, regulation. No, we don’t know and no I would never take them. Alcohol can be bad for quite a few people but at least you know what you’re dealing with.-
In one of the conferences, a radiologist said that now that he was mid career, his confidence levels somehow dropped and he was second guessing himself a lot of the times and would recheck his case reads. However, he also said cyclical dips in confidence is a known problem and corrects itself.
To Op: If this sounds familiar, hang on. Also, if the work is stressful, and is causing anxiety in your non work related activities, you need to cut back on reading studies or find a different job. Also, hopefully spend less time on computer in general and go out for walks/ runs/ hikes.
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Changing your work environment to one that is more conducive to your mental health is the best option in the long run. A more conducive work environment is better than taking any medication or counseling/talk therapy. I suggest looking for a new job.
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^^ How do you know the next one will be better and more conducive?
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Quote from Drrad123
^^ How do you know the next one will be better and more conducive?
Simple mathematics. Look at what you are currently reading on your Powerscribe list in a given amount of time M-F and weekends/nights. When you interview at a new job, look at what several of the radiologists are reading on their powerscribe lists in a similar amount of time and days. Make them pull up the powerscribe list for multiple people on multiple days. This is key, as Radiologists tend to underestimate and misrepresent the misery factor during PP interviews. Compare case mix etc.
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Ssri should be last resort. 50 years from now docs will shake their heads at those dirty drugs.
Talk therapy. Meditate. Yoga. Long walks. Basically anything that increases vagal tone. Most of these things are free, but take time.-
Stress makes it worse.
Taking a job with lower case complexity and less volume demands will help.
A less sophisticated medical community and less affluent patient population will be better in my experience.
Radiology leaderships which is supportive helps a great deal, but good luck with that in employed settings.
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Quote from Bdr123
Do most of you turn off once you leave work until the next time your back. Anyone have worries about cases and look again later at home to make sure? Or stay later in a shift to check your work? When would you say this is a problem and not just concern for your patients and work?
I put a reminder on my calendar to follow up on the case the next day or later.
It becomes less common with more experience.-
This isnt about reminder to follow up on cases with regards to original poster.
These are intrusive persistent bothersome thoughts that cause worry about cases read in the past. Perhaps not seeing something, or forgetting to look at something.
Based on what poster writes, this is followed by compulsive checking to relieve the anxious thoughts. Thats much different then following up on a case.
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When you put it that way it sounds more sinister.
I don’t know if I’ve felt that about cases. Maybe some early on. Not anymore. I just try to be careful and hope for the best. The only way to avoid making mistakes is to not read cases
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^^ thats a good attitude since there is only so much control. I think the original poster has crossed the line since the problem effects his productivity and interferes with his time away from work.
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Quote from Rd246
^^ thats a good attitude since there is only so much control. I think the original poster has crossed the line since the problem effects his productivity and interferes with his time away from work.
It also depends on the setting. For example, if you are in academics you can have fellows monitor the list.
In private practice you can ask the techs to do it for you. -
Reading back on this I am tempted to say most radiologists, just like the rest of the world, would benefit from a meditation practice.
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It all depends on the practice set up.
For example someone like dergon gets paid 95/RVU by abusing other radiologists.
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^^ agree about meditation.
Sounds like original poster always has cases haunt him after hours. Always worried about mistakes or having not looked at something on a scan.
Seems like his job is destroying his quality of life outside of work. Maybe burnout, anxiety disorder, severe stress?
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Ask fw.
He is a smart guy.
He married his wife only for money. Their sex life is terrible and he feels terrible. But at least he enjoys her money.
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