For an audio version of this post, please click on the speaker icon (top left).

 

 

The Complete Series Of Everyone Needs A Little Radiologist In Them:

• Mental Checklist.
• Part I.
• Part II.
• Part III.
• Part IV.
• Part V.
• Part VI.

 

Ok, before this post devolves into something sexual (a la, “That’s What She Said”), let me explain.

I apologize to the non-physician viewers who have not likely witnessed the following scenario firsthand, but I will try to explain so that everyone might be on the same page.

One of the great teaching experiences in a young medical student/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, said victim will be asked to interpret the study and point out any salient features.

I personally 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?

There is nothing on the film that a radiologist views that cannot be seen by anyone else.

The finding is there the whole time.

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.

There are many distractions that 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
• A high priority stat study that needs to take precedence over the current study being viewed

 

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.

Further elaboration of this answer is necessary.

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 study is ordered, it creates a distraction.

This distraction then interferes with continuing to evaluate the rest of the study.

This behavioral phenomena is called, “Satisfaction of Search.”

It is a phenomena 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 checklist/algorithm 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.

“That’s great Xrayvsn.   But how does this apply to me?  I’m not going to be reading films in the foreseeable future!”

Ahhh, young Padawan.  Be patient.

I’m about to tie it all up in a pretty little bow for you.

 

 

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 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.

 

 

 

 

Superpower Take-home Points:

1. Having a mental checklist/algorithm in place for all important life decisions is key.
   • An Investment Policy Statement (IPS) can help prevent making mistakes by allowing you to ignore outside distractions that can potentially block your path to success.
2. Satisfaction of search may cause you to prematurely end proper analysis of a potential opportunity and expose you to increased financial risk secondary to lack of due diligence

 

 

Note:

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 of finance.”

Even a steadfast DIY’er can sometimes gain benefit from the occasional professional input.

 

 

-Xrayvsn