One of the great teaching experiences in a young medical student or resident’s life is to be placed in front of his or her peers with an attending physician quizzing him or her on the spot about a particular patient.
Often, when radiology imaging is involved, the said victim will be asked to interpret the study and point out any salient features.
I have been subject to this numerous times in my medical training. I would hold up the film (yes, I am old enough to have trained before the digital age revolutionized radiology for the better), stare at it, do my best to recall the relevant anatomy, and then sputter out an answer.
Anyone who has undergone this firing squad method of teaching can attest to the following phenomena: After you do your best to find out whatever abnormality they were trying to coax out of you in film interpretation, the radiologist would intervene, use his magic red marker wax pen, and circle the finding in question. All of a sudden the abnormality became blatantly obvious. That red wax marker did not magically create the abnormality out of thin air. It was there all along and present for even the untrained eye to see.
So what is the radiologist’s secret?
Sure, as radiologists, we have a large storage of anatomy information in our heads. But every physician who has gone through the rigors of gross anatomy class has a similar repository stored. And typically the findings in question are not subtle in retrospect.
At the risk of being shunned by my fellow radiologists, much like a magician who is never supposed to reveal how a trick is performed, the key is — we follow a mental algorithm checklist with every study we interpret.
When I interpret a study, say an X-ray, for example, I have a set pattern that my eyes travel over the film (each radiologist is different in the actual pattern, but the key is that there is a set pattern).
I do not care what the presenting symptoms of the patient is. I do not care if the clinician specifically asked to “rule out” X, Y, or Z. That information can prejudice me and serve as a distraction. If I only look specifically at what the referring service is interested in, I can entirely miss something more sinister that was present incidentally.
Many distractions can happen when I interpret a film. The ordering physician can be present during initial interpretation specifically trying to direct you to his or her area of concern — numerous interruptions with phone calls or technologists walking in to get advice on a particular study.
Without a defined mental checklist tailored to each specific type of study/modality, it is easy to be thrown off one’s game and miss a vital step.
When I was in academics as an associate professor in my former residency program, I would often pimp the medical students/residents by asking, “What is the most commonly missed fracture?”
I would get responses all over the spectrum, listing various bones, etc.
The answer I was looking for in particular was the second fracture. The reason why the second fracture is missed highlights the point of needing a mental checklist to avoid distractions.
When someone interprets an X-ray, for example, and a source is indeed found to account for the reason that a study is ordered, it creates a distraction. This distraction then interferes with continuing to evaluate the rest of the study.
This behavioral phenomenon is called “satisfaction of search.” It is a phenomenon that every good radiologist must recognize and disregard.
In essence, your mind is satisfied that you have adequately given a reason to explain the patient’s condition and begins to shut down. Why keep looking for a four-leaf clover when you already found one? By prematurely finishing the film interpretation, you set yourself up for missing that second fracture (or something worse). By rigorously sticking to that mental algorithm checklist the radiologist continues to scan the remainder of the study and can thus pick up additional findings that someone who does not adhere to this pattern will miss.
In everyday life, there are far more distractions that come at you than I can possibly have sitting in my darkened room at work interpreting studies. The key is to not let these distractions redirect you on your planned course.
In finance, in particular, we are constantly bombarded by media and “financial gurus” telling us about the next big thing or, conversely, trying to stir up panic with predictions of catastrophic impending financial doom.
A perfect example was the Bitcoin craze. It was hard to ignore the stories that bombarded us on a daily basis of how bitcoin was the next big thing and made everyone who invested in it multimillionaires and that we better hop on board the bitcoin train lest we miss it.
This is where having a mental checklist, in this case, your Investing Policy Statement, helps analyze if this is indeed a distraction or something that fits in your plan. When evaluating a potential investment opportunity, do not just rely on information provided by the provider of said investment opportunity. Instead, do your own due diligence so that you do not fall trap to the “satisfaction of search” phenomena by just reading potentially biased information and agreeing to it.
Be wary of financial advisors who work on a commission basis and profit by steering you to investments that may not have your best interests in mind.
If you diligently follow your mental checklist and avoid distractions that can derail your goals, you will indeed have “a little radiologist in you” and set yourself up for future success.
“Xrayvsn” is a radiologist and can be reached at his self-titled site, XRAYVSN.
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