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Letter to a new resident
Cabbages
and Kings Melvyn H. Schreiber, MD, Editor
Letter to a New Resident ear Junior Colleague, The burden and enlightenment of the years have emboldened me to offer suggestions as you begin your radiology residency. You may think of it as fatherly advice if you wish. Chances are good that by the time your residency is over, the rest of the faculty and I will think of you as one of our children. 1. Treat your radiology department with respect, pride, and loyalty. Think of ways to improve deficiencies rather than criticize and complain. As Lyndon Johnson once said, "Don't spit in the soup. We've all got to eat." 2. Participate in the creation of team spirit among your residency group, particularly your peer group. Do nothing to embarrass one another. Friendly competition is appropriate, but anything more than that is divisive and should be avoided. 3. Discipline yourself to read daily about disease processes that you encountered recently. Follow up interesting cases that you see to determine whether final proof has b e e n obtained. H o w can you tell someone you saw an. interesting case of ileal carcinoid if you don't k n o w that's what it turned out to be? 4. Establish your own professional standards, and set your sights high. Don't be affected by any peer's lesser efforts. I am talking about the moral ground of your professional life. 5. Don't be satisfied with descriptive film interpretation. Understand why a thing looks the way it does. Understand and pay attention to clinical clues to the diagnosis. The radiologist w h o makes the consistently best interpretations usually has an intimate knowledge of clinical medicine. 6. Talk to patients, and pay attention to your patients' names. They will appreciate it, radiology will become more alive for you, and you are likely to learn important historical information that will help with differential diagnoses. Develop the habit of saying the patient's name out loud w h e n you examine a requisition prior to film inter-
D
pretation. It will remind you that the images you are about to see are a reflection of a real person. Keep your eyes and ears open. Heed Henry James' advice: "Be someone on w h o m nothing is wasted." 7. In both oral presentations and dictations, express yourself succinctly and systematically. Press yourself to be more than an enumerator of possible diagnoses (i.e., give weighted differential possibilities, with the most likely first). If the best you can do is to say that findings are "consistent with" a certain diagnosis, it might be better to consult with others. 8. For radiologists, communication is everything. We have not completed our duty w h e n we have discovered an important finding. Call the referring physician and tell him or her what you found. Make sure the patient has an appointment to follow up important findings. It is inexcusable to allow important findings to make their way to the referring physician by mail the next day or week. 9. Everyone makes mistakes. Try not to be one w h o makes the same mistake twice. 10. The hardest thing to learn is variations of normal. More mischief is done by mistaking normal for abnormal than missing an obvious abnormality (which someone else will detect). Your personal range of normal variation is narrow in the beginning and grows wider with experience. The only way to gain that experience is to read lots of films, including lots of normal ones. 11. Don't let casual attire or casual behavior demean your professionalism. You may not think that the way you dress or comb your hair affects your practice of medicine, but patients think so, and their thinking makes it so for them. 12. If you don't understand the technical aspects of your work, you will not be in a position to correct mistakes in technique or positioning. Spend as much time as it takes to familiarize yourself with the work of technologists, and be prepared to handle some technical duties yourself.
525
CABBAGES AND KINGS
13. Computers are critical to the future of radiology and therefore critical in your future. Computer literacy is a minimum; computer sophistication is the goal. 14. Finally, don't get so b o u n d up in your duties and responsibilities as a physician that you ignore your family and friends. Being the best radiologist in captivity will not begin to substitute for the affection and acceptance of those close to you, with w h o m you share your life. Your family identity and personal destiny must never be eclipsed by your professional identification.
526
Vol. 3, No. 6, June 1996
Congratulations on choosing a splendid specialty field. May good fortune follow you everywhere. Sincerely yours, Grizzled Veteran Melvyn H. Schreiber, MD University of Texas Medical Branch Galveston, TX Note: Many of these ideas, which express elements of our shared value system, came from Ja,ck Wittenberg, MD, of the Massachusetts General Hospital and Harvard Medical School.
and Kings Melvyn H. Schreiber, MD, Editor
Letter to a New Resident ear Junior Colleague, The burden and enlightenment of the years have emboldened me to offer suggestions as you begin your radiology residency. You may think of it as fatherly advice if you wish. Chances are good that by the time your residency is over, the rest of the faculty and I will think of you as one of our children. 1. Treat your radiology department with respect, pride, and loyalty. Think of ways to improve deficiencies rather than criticize and complain. As Lyndon Johnson once said, "Don't spit in the soup. We've all got to eat." 2. Participate in the creation of team spirit among your residency group, particularly your peer group. Do nothing to embarrass one another. Friendly competition is appropriate, but anything more than that is divisive and should be avoided. 3. Discipline yourself to read daily about disease processes that you encountered recently. Follow up interesting cases that you see to determine whether final proof has b e e n obtained. H o w can you tell someone you saw an. interesting case of ileal carcinoid if you don't k n o w that's what it turned out to be? 4. Establish your own professional standards, and set your sights high. Don't be affected by any peer's lesser efforts. I am talking about the moral ground of your professional life. 5. Don't be satisfied with descriptive film interpretation. Understand why a thing looks the way it does. Understand and pay attention to clinical clues to the diagnosis. The radiologist w h o makes the consistently best interpretations usually has an intimate knowledge of clinical medicine. 6. Talk to patients, and pay attention to your patients' names. They will appreciate it, radiology will become more alive for you, and you are likely to learn important historical information that will help with differential diagnoses. Develop the habit of saying the patient's name out loud w h e n you examine a requisition prior to film inter-
D
pretation. It will remind you that the images you are about to see are a reflection of a real person. Keep your eyes and ears open. Heed Henry James' advice: "Be someone on w h o m nothing is wasted." 7. In both oral presentations and dictations, express yourself succinctly and systematically. Press yourself to be more than an enumerator of possible diagnoses (i.e., give weighted differential possibilities, with the most likely first). If the best you can do is to say that findings are "consistent with" a certain diagnosis, it might be better to consult with others. 8. For radiologists, communication is everything. We have not completed our duty w h e n we have discovered an important finding. Call the referring physician and tell him or her what you found. Make sure the patient has an appointment to follow up important findings. It is inexcusable to allow important findings to make their way to the referring physician by mail the next day or week. 9. Everyone makes mistakes. Try not to be one w h o makes the same mistake twice. 10. The hardest thing to learn is variations of normal. More mischief is done by mistaking normal for abnormal than missing an obvious abnormality (which someone else will detect). Your personal range of normal variation is narrow in the beginning and grows wider with experience. The only way to gain that experience is to read lots of films, including lots of normal ones. 11. Don't let casual attire or casual behavior demean your professionalism. You may not think that the way you dress or comb your hair affects your practice of medicine, but patients think so, and their thinking makes it so for them. 12. If you don't understand the technical aspects of your work, you will not be in a position to correct mistakes in technique or positioning. Spend as much time as it takes to familiarize yourself with the work of technologists, and be prepared to handle some technical duties yourself.
525
CABBAGES AND KINGS
13. Computers are critical to the future of radiology and therefore critical in your future. Computer literacy is a minimum; computer sophistication is the goal. 14. Finally, don't get so b o u n d up in your duties and responsibilities as a physician that you ignore your family and friends. Being the best radiologist in captivity will not begin to substitute for the affection and acceptance of those close to you, with w h o m you share your life. Your family identity and personal destiny must never be eclipsed by your professional identification.
526
Vol. 3, No. 6, June 1996
Congratulations on choosing a splendid specialty field. May good fortune follow you everywhere. Sincerely yours, Grizzled Veteran Melvyn H. Schreiber, MD University of Texas Medical Branch Galveston, TX Note: Many of these ideas, which express elements of our shared value system, came from Ja,ck Wittenberg, MD, of the Massachusetts General Hospital and Harvard Medical School.