A Radiology Rant: Just Push the F**king Button

RadiologyIf you are under my care in hospital it is exceedingly likely that I am going to image you in some way at some point, and so you will become involved with the department of Radiology. Radiology is run by doctors called Radiologists and they are supported by technicians called Radiographers. For those of you considering a career as a radiologist then check out the website of their Royal College. They use radiation to provide images (such as X-rays and CT’s) mostly for diagnostic purposes and interpret the findings based on the clinical information provided. Some also have a therapeutic role as “interventional” radiologists and perform image guided procedures.

I have no issue with the interventional guys, they are the good guys usually and are helpful and normal (at least in this hospital). The problem lies in the nature of their working pattern compared to mine, I am resident, they are on call from home; the classic of example of this is the weekend. Saturdays to radiologists are calm and quiet affairs, they should involve breakfast in bed, perhaps a newspaper or two and then a walk along the beach with a labrador to get some colour in their cheeks (all radiologists are pale, they spend a lot of time in the dark). Then, maybe, they could go into the hospital and do a CT head of a GCS 7 head injury before returning to their family for tea.

My weekend looks like this: 14 admissions, 3 paeds admissions, 4 ward referrals, 2 appendicectomies, 2 laparotomies and an HDU full of wrecks. I don’t give a fuck that it is Saturday, Mrs Goggins has pain, Mrs Goggins probably has acute cholecystitis, I’ll take her gall bladder out on Sunday because it needs doing, but I can only do it if they do an ultrasound of the inflamed little beast on Saturday and confirm the diagnosis. The on call radiologist once did a surgical job, back in 1982 in some district general hole that only operated on the dying “out of hours” and certainly didn’t take out gallbags on a Sunday morning and so he erroneously assumes that KBW has the same view.

The radiologist does not want to come in from home to scan Goggins’s Gallbag, he certainly will not miss Saturday Kitchen and seeing little Joanna play hockey to do an ultrasound on somebody he believes will not get operated on until Monday. He thinks I should give the woman some antibiotics and get the scan on Monday morning, first thing. This is a perfectly acceptable plan if it was 1982, but not exactly best practice nowadays. I wonder how my radiology friend would feel about his own dear mother or wife coming in needing an operation and delaying treatment because it is the weekend, how different it would all seem then.

I have a trump card I can play, that I have only played once partly because I am a coward and partly because I have someone to fight these battles for me. I have seen the patient, they have not, I am the clinician and they are not, I have overall responsibility for this person and they do not. It’s a brave Saturday Kitchen viewer who tells me that they are not doing the scan when I write in the notes that in my opinion they have to have it and that the test has been refused. Mrs Goggins could wind up in ICU in septic shock, which makes my radiology friend look rather bad if it all ends up in court.

I have to phone my colleagues in radiology at home from the hospital where I am resident and busting my ass, often not eating or peeing for 13 hours and ask them to please, please come and do the CT or ultrasound scan, then I have to grovel and thank them so much for doing it. I interpret the images myself most of the time (all surgeons should be able to look at CT scans and understand what they are seeing in my opinion) and frequently they review the films from home and it is the radiographers that have to come in to do the scan so there is actually little interruption to their day.

I wish they could see things from my point of view, they wish I could see theirs. Inevitably they will have to accept that the notion of being “on call” does not mean life or death only and that we have to deliver excellent care at night and at the weekend as well. Consultant delivered care is the current stick with which we are being beaten by management and that means if we are in providing consultant delivered surgical care 24/7 the radiologists are going to have to back us up, even if it is just to push the fucking button.


Don’t get ill today; black Wednesday

Fresh meat.

Fresh meat.

This morning saw a  fresh batch of junior doctors start on the wards. It is joked about and dreaded in equal measure. The reality is that they are pretty well prepared and most of them do fine, give or take a few wobbles. In fact in spite of me experiencing this new doctor scenario 13 times now the only time I can recall in any detail is my own first day. Strangely it is not the difficulty in inserting a cannula, the prescribing errors, wrong diagnoses that I remember from those first few days, it is how I was treated by senior colleagues and nurses.

I do expect that they try their best, that they make the care of their patients their first concern and that they work hard. FY1’s are very well paid compared to other graduates and should be prepared to work long and hard shifts where they will be pushed to meet very challenging situations.

It is very tempting to play naughty tricks on them, much like the culture was when I joined. People were sent to theatre for a long stand, they were asked trick questions, they were bullied, teased and treated like crap.  I know that the little team of new and terrified juniors under my care today will remember how they get treated more than who they treat and so for my part I plan on being a good guy.