Easier ascent in the saddle

At the end of my first vacation in about a year and a half, I prepared for the impact by resuming my normal working hours, which is nothing new to me, but has diminished over the years as I “changed” from one job to another.

I imagine this is an almost universal phenomenon, unless you are madly happy in your vocation, to the point of doing so even being financially independent and needing no income, the return of a break will always have nasty aspects. Having to go back to a regular schedule, taking responsibility rather than doing what seems like a momentary pleasure, and of course things that teleras like me have put aside (dressing professionally, getting around).

Back at the start of my residency, a week had a jarring impact on my entry-level radiology skills. Now, with over 20 years of practice, I can hardly conceive of feeling that way. Maybe if I took a whole year off? Maybe not even then; the rads could be permanently etched on my brain now.

Once the training was over and moved to private practice, I encountered new wrinkles in post-vacation pain, which looked like punishments for taking time off. I walked through the door of my workplace and it would be as if a series of traps had been set to “welcome” me.

For example, there would invariably be a very large pile of studies I could read, accumulated over the days I was away. I wasn’t the only one able to read them, but I might as well have been. Of course, things could have been busy in my absence; maybe the rads covering my spot just couldn’t do it all, but I still felt like I was reading most of the studies I would have had if I hadn’t been away at all.

In my absence, a certain number of referees would also accumulate wishing to speak about studies that I had read, or requesting addenda to my reports, for example because it is only after having read their cases that they had taken the trouble to provide CDs of previous analyzes to other facilities for comparison.

I couldn’t blame the other rads for not wanting to deal with these things – I read and knew the cases, when they should start from scratch and hope they didn’t disagree with my interpretations. Most sitting rads will know, however, that many of these addendum requests are time-consuming rubbish.

(An example I heard about on the first day of my return, from another rad: Some providers wanted a thyroid ultrasound addendum because it was reported with measurements in centimeters – they wanted an addendum to describe it all in millimeters instead.)

When I switched to Telerad, the phenomenon of stacked cases disappeared; the per click model is to always have a full working list for rads. Anything I wasn’t there to read would have been picked up by another hungry person. Even some of the “clinicians want to talk” and addendum requests have been addressed, possibly by vRad section heads. I mean, if someone took the risk of challenging / canceling my relationships, someone in their high role should do the trick, right?

The vR system, however, introduced new post-vacation penalties. I wrote in this column before that their quality assurance left something to be desired, one of them being that you would find out that you had problematic cases when you first logged in for a shift. A tab at the top of their RIS page would be a threatening red, and you should click on that to see a list of charges against your jurisdiction / conscience. The longer it was since you last logged in, the more time it took for this list to fill up.

Maybe it’s my psychiatrist’s degree speaking, but it seems to me that punishing someone every time they come back from vacation is not a great way to make them feel good about the job they are returning to. . It would probably be better to find ways to make it easier for them to get back into the saddle. Even make it enjoyable, if possible.

As circumstances vary so widely between radiology practices, there is no one-size-fits-all solution. I would just start by asking people around me what the different rads found annoying about coming back from a break, and finding remedies for the complaints.

For example, in groups like my pre-telerad jobs where backlogs develop and a returning vacationer tends to be greeted by a stack of studies reserved for him: put him on a rotation not demanding for his first day back.

Your group forced him to play catch-up, so don’t interrupt that with just any usual parade of STAT readings, fluoro cases, diagnostic mammos, contrast injections, etc.

If you have daily productivity quotas, maybe let go of his while he processes a bunch of accumulated addendum requests and returns the calls to a bunch of referrers. Unless of course your system has a mechanism to count such activity such as pseudo-RVUs.

Err on the side of overcompensation; Making people’s first day back to work exceptionally easy is better for their morale than not making it easy enough. If they happen to not get back into trouble, or if they aren’t caught off guard at the start of the day, they can always take more on themselves. An appreciative display of teamwork: “Thanks for the help, but things are going pretty well here; return me to full capacity.


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