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  • Transitioning to a busier practice

    Posted by marcioradiologia2_129 on August 9, 2023 at 3:07 pm

    Curious if anyone has made the move successfully from a relatively lower to high volume group/position (perhaps for better schedule, pay, or change in location). What was the transition like? Do you find yourself comfortable in your position now, or at least see it as something stable and doable for the long run? Any changes in your reading style or dictation?
     
    And for higher volume readers, what redundancy do you have built into your search pattern, both for avoiding misses/blind spots and for efficiency? For instance maybe you have overlap in attention to adjacent anatomical fields while scrolling up and down or look at organs in more than one plane letting certain structures be observed twice or more (avoiding misses); or maybe you look at two or more different structures at the same time scrolling through once (efficiency)? What inefficiencies have you noticed in others or learned to let go of yourself?

    Unknown Member replied 9 months, 1 week ago 9 Members · 14 Replies
  • 14 Replies
  • consuldreugenio

    Member
    August 9, 2023 at 4:53 pm

    I look at some structures on multiple planes such as kidneys. For sure with joint MRIs. But a lot of structures get a single pass. I do like looking at the brain with thin cuts after doing standard views. Some hemorrhages tend to pop. 8-10 mm MIPS lung windows for nodules always. 3 views for bone windows on CT body and C spine cases.

    Doing just a little extra compared to your colleagues will make you look like some sort of deity as you will catch more things.

    • alex.nieto_484

      Member
      August 10, 2023 at 4:43 am

      Quote from PneumoRad

      I look at some structures on multiple planes such as kidneys. For sure with joint MRIs. But a lot of structures get a single pass. I do like looking at the brain with thin cuts after doing standard views. Some hemorrhages tend to pop. 8-10 mm MIPS lung windows for nodules always. 3 views for bone windows on CT body and C spine cases.

      Doing just a little extra compared to your colleagues will make you look like some sort of deity as you will catch more things.

      This sounds like advice of someone moving from a high volume to a low volume place

      • skysdad

        Member
        August 10, 2023 at 7:04 am

        A lot of speed can be gained just by technical/ergonomic factors. Using findings mode, good default templates, hotkeys, learning to speak clearly, training problem words, fine tuning your search patterns to minimize backtracking, etc.

        If the high volume is something like ED volume as opposed to complex inpatients, or cancer followups, then you can really go to light speed. No one in the ED needs 3 dimension measurements of simple renal cysts. If a skinny 25 year old man comes in after wreckig his dirtbike, do you have to spend 10 minutes finding the appendix when the RLQ structures otherwise look fine with no inflammation?

        Ultimately, you learn to read faster… by reading faster, as unhelpful as that sounds. Harder to do outside of training, but perhaps you can have a speed run of each case, followed by a slow run and titrate until the miss rate of A is closer to B.

        • elikot

          Member
          August 10, 2023 at 7:37 am

          1. Keep your templates short. 
          2. get your hanging protocols perfect.
          3. Use findings mode if possible.Allows you to focus on the images, and not on the words in a report, which in turn lessens fatigue of going back and forth between screens, and keeping your eye on the images will lessen misses.
          4. Minimize unneeded verbage  for simple reports. normal cxr does not need 3 paragraphs. Same with bone films. 
          5 Anything else you can do to minimize button pushing and clicking

          • obebwamivan_25

            Member
            August 10, 2023 at 8:19 am

            Going to a busier practice:
            Don’t aim for the fences on day one, or even month one.  Pace yourself.  First you have to learn the PACS to become proficient.  HP as bostonrad1 says.  How does the practice report things?  Is there a standard template or do they allow each rad to decide for herself/himself how to report.
             
            How do communications work?  You have to figure all that out and it takes time.  Each practice and institution has a culture and rules, and you won’t get into the work until you have a good understanding of that.  Even if you were decades into your career, these are roadblocks.
             
            Mostly, I’d say be patient with yourself, trust yourself, ask for opinions so you can learn from the locals how they read (and it has benefit of them getting to know you and trust you), and once you get into a rhythm, speed will increase.  We all have quicker days and slower days but pace of reading really is easier when you get into that rhythm. 

            • sehyj1

              Member
              August 10, 2023 at 9:54 am

              Findings mode seems like a beast to start from scratch

              • elikot

                Member
                August 10, 2023 at 12:48 pm

                once you get going, setting up your findings mode is pretty fast .

                • obebwamivan_25

                  Member
                  August 10, 2023 at 1:03 pm

                  Quote from bostonrad1

                  once you get going, setting up your findings mode is pretty fast .

                  I’m pretty creative with Powerscribe, and voice in general.  I can’t get Findings mode to work consistently.  Once in a while but it is painful

  • tdetlie_105

    Member
    August 9, 2023 at 5:45 pm

    Quote from aeo

    Curious if anyone has made the move successfully from a relatively lower to high volume group/position (perhaps for better schedule, pay, or change in location). What was the transition like? Do you find yourself comfortable in your position now, or at least see it as something stable and doable for the long run? Any changes in your reading style or dictation?

    And for higher volume readers, what redundancy do you have built into your search pattern, both for avoiding misses/blind spots and for efficiency? For instance maybe you have overlap in attention to adjacent anatomical fields while scrolling up and down or look at organs in more than one plane letting certain structures be observed twice or more (avoiding misses); or maybe you look at two or more different structures at the same time scrolling through once (efficiency)? What inefficiencies have you noticed in others or learned to let go of yourself?

     
    It can be done but you will have to change your style and trim a lot of fat to get up to speed.  Seeing the quality/thoroughness of reports at your new place will give you clues as to what are acceptable short cuts.  I successfully made this change in the sense I was going to become a partner but moved out of state for family reasons.  In retrospect while I would have had a very high income, I think the stress/burn-out factor would eventually have caught up given my overall temperament…One of the audio books (non-medical) I recently listened to mentions how one can train an individual that reads (words not images) at a normal rate to become a faster read.  Similarly one can train a “speed reader” to actually read faster.  In both cases however there is decreased retention with respect to content so always a trade-off

    • Unknown Member

      Deleted User
      August 9, 2023 at 7:55 pm

      Read Thinking, Fast and Slow, by Daniel Kahneman

      The book’s main thesis is a differentiation between two modes of thought: “System 1” is fast, instinctive and emotional; “System 2” is slower, more deliberative, and more logical. It applies to radiologists, IMO

      Many fast readers use system 1, utilizing heuristics, essentially experienced shortcuts, to cut through the chaff. Unfortunately, it is less accurate, but is also less stressful and time consuming.

      That nodule in on a 28 year old’s cxr? Is it real, and if it is, does it matter?Heuristics would blow it off, odds are its nothing. System 2 thinking would scrounge for old chest radiographs for at least peruse the EMR; usually for naught, but not always…

      You have to look at the images, and there is a point where efficiencies can’t help. You have to figure out your ROC curve to some degree, and know your limitations. Don’t get forced interpreting past your abilities.

      • tdetlie_105

        Member
        August 10, 2023 at 3:58 pm

        Quote from boomer

        Read Thinking, Fast and Slow, by Daniel Kahneman

        The book’s main thesis is a differentiation between two modes of thought: “System 1” is fast, instinctive and emotional; “System 2” is slower, more deliberative, and more logical. It applies to radiologists, IMO

        Many fast readers use system 1, utilizing heuristics, essentially experienced shortcuts, to cut through the chaff. Unfortunately, it is less accurate, but is also less stressful and time consuming.

        That nodule in on a 28 year old’s cxr? Is it real, and if it is, does it matter?Heuristics would blow it off, odds are its nothing. System 2 thinking would scrounge for old chest radiographs for at least peruse the EMR; usually for naught, but not always…

        You have to look at the images, and there is a point where efficiencies can’t help. You have to figure out your ROC curve to some degree, and know your limitations. Don’t get forced interpreting past your abilities.

         
        This is a very intriguing post for me personally.  I started the audio book version of this about 5 years ago but lost interest.  What you describe makes perfect sense and I see this is my current practice.  Not only are our system 1 readers faster/more productive, they are the ones that have the bandwidth to take extra shifts/internal moonlighting.  I imagine they leave more with more energy as well.  I am innately a system 2 which explains why I find the work to be so soul sucking at times despite reasonable volumes.  Going to revisit that book

      • tdetlie_105

        Member
        August 10, 2023 at 4:02 pm

        Quote from boomer

        Read Thinking, Fast and Slow, by Daniel Kahneman

        The book’s main thesis is a differentiation between two modes of thought: “System 1” is fast, instinctive and emotional; “System 2” is slower, more deliberative, and more logical. It applies to radiologists, IMO

        Many fast readers use system 1, utilizing heuristics, essentially experienced shortcuts, to cut through the chaff. Unfortunately, it is less accurate, but is also less stressful and time consuming.

        That nodule in on a 28 year old’s cxr? Is it real, and if it is, does it matter?Heuristics would blow it off, odds are its nothing. System 2 thinking would scrounge for old chest radiographs for at least peruse the EMR; usually for naught, but not always…

        You have to look at the images, and there is a point where efficiencies can’t help. You have to figure out your ROC curve to some degree, and know your limitations. Don’t get forced interpreting past your abilities.

         
        This is a very intriguing post for me personally.  I started the audio book version of this about 5 years ago but lost interest.  What you describe makes perfect sense and I see this is my current practice.  Not only are our system 1 readers faster/more productive, they are the ones that have the bandwidth to take extra shifts/internal moonlighting.  I imagine they leave more with more energy as well.  I am innately a system 2 which explains why I find the work to be so soul sucking at times despite reasonable volumes.  Going to revisit that book

        • y.rajshekar

          Member
          August 14, 2023 at 6:19 am

          Is finding mode available in PowerScribe 360 v4?

          • Unknown Member

            Deleted User
            August 15, 2023 at 10:34 am

            System 1 readers rely on heuristics; decision making is less stressful, but less accurate. Thats a fact based on Kahnemans research.
            So lets say a system 1 reader misses 1 finding a year that leads to a patients death. Call it 1/12000. Seems trivial statistically. But its 30 lives over a career.
            How do you measure that cost? To the patient, its priceless.
            We cant be perfect, but we can be better. We cant eliminate mistakes, but we can create systems that minimize them. I dont think we pay attention to this, its easier to ignore.