Lessons from Radiology

I booked a Radiology rotation after match to get better at reading radiographs (and let’s be honest, I wanted a ‘rad-cation’ because 4th year). I can go on tangents about how grumpy I feel about long days on Radiology while everyone else on Radiology is usually out by noon, but I’ll focus instead on the fact that I am learning quite a bit on this rotation.

When we order tests for our patients, it’s very easy to forget that just because a test is listed on an EMR (electronic medical record), it’s not always an easy thing to go through. I’ve watched numerous speech evaluations in the past week and I cannot even describe how horrible it feels to watch an extremely sick patient try to swallow liquids and food of various consistencies coated in barium while at least 4 people stare at them do it. I understand many of these studies are necessary but there are some patients that are so obviously ill that you wonder if assessing aspiration risk is even necessary. If it weren’t so easy to click an order on the EMR, I wonder if it would be ordered as often.

When I had some health issues I was dealing with, I had THREE separate ultrasounds of my kidneys and bladder in the span of 1.5 years. The main reason they were ordered for me was to look for some sort of obstruction (like kidney stones or a mass) which would present as something called hydronephrosis (basically, swelling of the kidneys). I appreciated the fact that my doctors didn’t jump to a CT but the ultrasounds definitely weren’t easy.

In order to prepare for this imaging, the patient must come into the office at the time of their appointment with a FULL bladder. The idea is that they image everything with a full bladder and then once again after you’ve emptied. There was never a guarantee that you would be seen immediately because that’s not how clinics work. Nevertheless, the patient had to come to the exam prepared and ready to go. If by chance you come with a semi-full bladder because it’s more tolerable, they’ll make you drink more water and wait in a corner while they attend to other patients so you end up being uncomfortable anyway.

Can you imagine how agonizing that would be?

And here’s the kicker. Having a super full bladder for a certain period of time can cause transient hydronephrosis anyways (which my reports showed), so what do you do with that?! In retrospect, I feel it was weird to have so much imaging in such a short period of time. Ultrasounds are very operator dependent so I’m not sure if I can really take much comfort in my results and ultimately I feel the tests were ordered easily because everyone thinks of ultrasounds as super benign tests. My example is minor in regards to other complicated imaging procedures that patients are asked to endure, but I think the take away point is the same.

It really is essential to understand the nuances of the things we order for our patients. For example, if you have an admitted patient you need some labs on, think about how urgently you need those results. If it’s something that can wait until the morning, add it to the batch of morning labs instead of having them stuck with a needle on 4 different occasions in one day. Similarly, we should be careful about how we order imaging for our patients and think really hard about what it will show us regarding our treatment plan.

Anyways, thanks for reading!

-Bhuvani

(The picture in this post is from my mom’s garden in Minnesota last year)

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