Everyone Needs A Little More Radiologist In Them: Part III
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The Complete Series Of Everyone Needs A Little Radiologist In Them:
So here are more of the concepts I have gleamed from being a radiologist/physician and how I apply them in my everyday/financial world:
Radiology Concept #10
Clinical Correlation/The Hedge
As much as I am proud of the advancements in technology that has allowed Radiology to grow leaps and bounds even during my limited career, the day may never come where a 100% accurate diagnosis can be obtained based on imaging alone.
There are just too many variations in human anatomy and pathology to have complete confidence of a particular disease.
We all have memorized those “textbook cases” of various diseases in medical school and residency.
The problem is that the diseases do not read those textbooks and correspond appropriately (this might be a good thing for physicians because if they did artificial intelligence may be replacing us much sooner).
So radiologists are famous for what is called “The Hedge.”
Essentially the radiologist hedges his or her bet on a particular diagnosis.
I end every report I dictate with a section called “Impression:”
For a particularly challenging case I give my “hedge” and list a differential diagnosis of what the finding MIGHT represent (and there still remains a chance that the true diagnosis was never included in the differential no matter how many I give).
Sitting in a dark room with just the images in front of me also can put me at a disadvantage.
I do not have the patient to examine in front of me (to be fair, my clinical skills by this time have probably deteriorated to the point that the likelihood of me having a “Dr. House” moment is slim to none).
Because of this I sometimes “hedge” in my Impression to have clinical correlation for a particular finding.
The additional information garnered from actually placing hands on the patient combined with the imaging findings MAY make the diagnosis a bit more definitive or at least more likely.
Most likely you have come across the phrase, “Hedge one’s bets.”
In essence you make a large bet on what you think is the most likely winning scenario but in addition take out smaller bets to cover your losses in case the main bet does not come through.
It is basically the underlying principle of diversification.
Sure statistically stocks have outperformed most other asset classes with time.
However it is ill advised to go 100% “all in” on equities (unless you are very young and have a very long investing time horizon) because of the inherent volatility present.
Diversifying your portfolio with bonds and perhaps real estate helps to lessen your exposure for catastrophic loss.
Granted by minimizing losses the trade-off is blunting potential gains as these less risky assets typically have lower expected returns.
Radiology Concept #11:
“When you hear hoofbeats think horses not zebras.”
This was a phrase I was first introduced to in medical school.
The underlying premise to that phrase deals with how the prevalence of a particular disease matters when coming up with a thoughtful differential diagnosis.
It is more common to have an atypical presentation/finding be linked to a more common disease than that particular finding linked to a rare disease (even if that finding is a predominant presentation of the rarer disease).
Sure a radiologist can list every single potential pathology a finding on imaging may represent but this would be cumbersome for both the radiologist and the provider to wade through as well as having decreased utility.
Therefore most radiologist limit the differential to the top 3 or so disease entities that a finding is most likely to represent.
The majority of us know it is crucial to invest money in some form as tucking money under a mattress will have its value eroded over time due to inflation.
There are financial advisers/financial companies that want to get their cut in the investment industry and try and attract your attention (with hopes of getting some of your hard earned dollars) with exotic investment options.
These are truly the zebras in the investing world, some trying to combine insurance and investment into one product (almost always a bad deal) or having some unusual tilt in what types of products the money is invested in.
My advice is to stick with the pure thoroughbreds, the tried and true investment options such as the total stock and total bond index funds.
If you want something more exotic you are putting yourself in financial peril.
My suggestion is to either visit Africa or a local zoo and get that zebra fixation out of your system.
Radiology Concept #12:
The need for breaks.
It is vital to give your mind and body time to recharge from the daily abuse received from work.
The Work Day:
Some days it seems like a never ending influx of studies are piling up on my list that I cannot make any headway.
It is almost like the mythical Hydra, I slay one study and two more pop in its place.
In the past I have sacrificed bathroom breaks, food breaks, etc to try and keep the list more manageable.
Soon I realized I was doing more harm than good.
Without periodic breaks you can experience headaches, visual changes (especially when looking at 50 or so mammograms in a day), and loss of concentration.
Sometimes I would find myself unsure if I had finished a particular item on my checklist for review and find myself repeating the examination.
This loss in efficiency was far more detrimental to workflow than if I had just taken my standard breaks.
The Work Week:
As discussed on previous posts there was a time where I felt that burnout was starting to get a hold on me.
Even though by physician standards I had an incredible work schedule (Mon-Fri, 8:30-5pm, no nights, no weekends, and no call), it still did have impact on my overall mental state.
My best decision was to reduce my clinical hours by scheduling coverage for one day a week (alternating between a Monday off and a Wednesday off).
That one day off a week made a world of difference and allowed me to recharge my dying batteries.
It gave my body and mind an extra day to recoup which resulted in me being able to better attack the list on the days I did work.
The Work Year:
For the longest time I would plug along working without taking vacation.
When I was married I know for a fact that I went 3 years without taking time off besides what was given for major holidays.
I get compensated by the “eat what you kill” method, which meant the more I worked, the more I would pad my bottom line.
Conversely any time I took off meant I would have to pay someone to cover me which would have a negative financial impact on me.
I used this to rationalize why I did not want to go on vacations (another big part was I actually did not want to spend more time with my (now ex-) wife.
In the end I again did more harm than good.
Vacations are a good way to get away from it all and inject some much needed rest and enjoyment back into your life.
By forgoing vacations, I accelerated my path to burnout.
I have since learned my lesson and now enjoy traveling (especially now that I have a partner I can truly enjoy these experiences with).
It may seem like you are losing money going on vacations or taking days off,
However, by prolonging your medical career by preventing burnout, taking a break can be a wise financial decision in the long run.
Please stay tuned for subsequent installments in this multi-part series.
If you are in search of financial help, please consider enlisting the service of any of the sponsors of this blog who I feel are part of the “good guys and gals of finance.”
Even a steadfast DIY’er can sometimes gain benefit from the occasional professional input.
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