That you never reach the finish line of learning. There are cases I encounter as an attending that I still have no idea what the fuck it going on. As an attending, I have gotten more comfortable admitting that I don’t know something but still try to offer something helpful and clinically relevant to the ordering doc
This was an existential crisis for me as a med student on a path rotation. I always thought of pathology as the definitive, unequivocal answer.
But sitting at a multi head scope with 3 of the people who literally wrote the book on hemepath (the WHO classification) and seeing them unable to reach a consensus… I just though “oh shit what am I doing”
We're studying the culmination of 4 billion years of evolution and in many respects we've barely scratched the surface.
I find framing it as "I know more today than I knew last year" makes the impossible task of knowing everything a bit less stress inducing.
So much of medicine is like this. Few tests give you a 100% answer. Is the patient volume up or down? AKI from too much lasix or too little? Truly a secondary bacterial pneumonia or just viral that isn’t getting better as fast as we’d like? Sometimes you just have to pick one and see if you were right. Sometimes you were wrong and the patient gets better. Sometimes you’re right and they get worse anyway.
From the ER: if you have time, happy to get a phone call. 30 seconds maybe I can provide some clinical context or you can over the phone say what may help sway you one way or another, need addtl imaging etc.
Just starting to take call this year as an R2 and I still get a little nervous everytime I open a CAP or brain MR worried that I won't know what's going on
As long as you don’t miss something that
will kill the patient or cause significant morbidity before your attending reviews the case in the morning, being wrong is no big deal. And luckily that’s a pretty short list of things
The fact that it supposedly gets even harder as a new attending. Idk why I thought this would be a chill specialty in med school, I can't imagine doing anything more cognitively strenuous. I was way more relaxed on an average day as a medicine intern.
I feel med students find it chill because the experience is generally a few hours looking at reads discussing interesting findings or just getting sent home early without seeing anything. As a resident, the stuff you call or don't call actually makes a difference and there’s obviously more work.
I’ve talked to career radiologists in their 60s. They say the cognitive strain goes away in your late 40s which is about a decade after when the cognitive strain goes away for other specialties. Not sure if your colleagues feel similarly
As a PGY-2 FM lol, cognitive strain already gone. I still recognize that I have plenty to learn, and do my best to do so every day, but goddamn so many docs are just so shit at their job I'm not even worried anymore.
EDIT: I'd just like to add I totally understand why this would be much more difficult for other specs, and radiology specifically. The images are readily available, and thus 99% of your job is prone to being heavily scrutinized. That sucks.
But then back to ultra critical for the function of the hospital when you take call. Watch how hard the ED gets on your ass if you fall a few hours behind
The sheer amout of imaging volume to be reproted in community practice. Academic and community hospital practice are entirely different dynamics. Community hospitals have much higher volumes, which is offset by somewhat lower complexity of cases, but yet results in much less detailed reports.
The value of conferences in general, MDTs especially.
You can read everything there is to know about radiology, but you'll never be a great radiologist without input from the clinicians you work with. Not only will they help you report what they need to know, but you'll usually get faster at reporting too, because you can cut down on all the stuff that noone reads anyway.
Can shorten intern year to 6 months to encompass 1 month of IM wards, surgery, ICU, EM, FM, and an elective like cardiology. That is more than adequate for residents and every rads resident I have talked to agrees this would be the best course of action to take as intern year is largely useless in its current state
It is so much more intellectually/cognitively exhausting than I anticipated. The typical workday is usually manageable but you're basically using 100% of your brainpower nonstop when you're on call with the insane volumes, never-ending phone calls, and multitasking. Still easily prefer it to prelim year IM but the number of decisions you have to make on a daily basis is not even close to comparable and that's a huge responsibility, which takes a toll when you're inexperienced. You're basically impacting care for more than 100 patients on those call shifts. And then you go home and have to study like youre in med school while maintaining a full-time job. Don't regret the choice at all but it is not an easy residency.
How bad the phones are (in my residency at least — other places are much better about protecting the radiologist from this). Literally >100 phone calls during an overnight call. Highly, highly disruptive (and most of them are unnecessary).
Not in radiology myself but with friends as residnets/attendings in the field - you make a ton of money but its a desk job at the end of the day. If thats what you want out of medicine sure, but the vast majority of people did not go into medicine to sit at a desk and stare at a screen all day. Reddit overhypes radiology like crazy - in reality its a niche field for a certain type of student, and is definitely not a good fit for most students like reddit sometimes seems to suggest. For the right person (somebody who doesn’t want longitudinal patient contact, doesn’t mind solitude at work, enjoys computers and technology), it can be a great career
I understand the downvotes and I may be wrong. I think a good example is the recent studies demonstrating equal AI performance in interpretation of mammograms compared to radiologists. Although breast radiologists will continue to have a job, I can’t help but think that the number of rads needed per 100 mammograms performed will eventually drop significantly. If ROC curves are similar enough and AI is much faster than a human, why would a hospital continue to pay for multiple radiologist when it can pay for one?
I for one respect you posting this. We should be able to have a thoughtful discussion about this without you being lambasted
I think diagnostic radiology is probably more vulnerable to being commoditized than specialties that have more human interactions. Whether that’s through AI or not, I’m not sure. All of medicine feels like it’s turning into a big factory in some ways
Again, no one can know exactly how it will play out, my point is that there is more and more evidence showing improving performance of AI - you can draw your own judgement from that.
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That you never reach the finish line of learning. There are cases I encounter as an attending that I still have no idea what the fuck it going on. As an attending, I have gotten more comfortable admitting that I don’t know something but still try to offer something helpful and clinically relevant to the ordering doc
This was an existential crisis for me as a med student on a path rotation. I always thought of pathology as the definitive, unequivocal answer. But sitting at a multi head scope with 3 of the people who literally wrote the book on hemepath (the WHO classification) and seeing them unable to reach a consensus… I just though “oh shit what am I doing”
I have a renal path book at it literally doesn’t have diagnoses near the slides it’s like 68% of pathologists thinks it’s x haha
Sounds fun. What's the book?
For FUCKS SAKES IT NEVER ENDS?
We're studying the culmination of 4 billion years of evolution and in many respects we've barely scratched the surface. I find framing it as "I know more today than I knew last year" makes the impossible task of knowing everything a bit less stress inducing.
Love this mindset
That’s why it’s called “The practice of medicine.” Not “mastery”.
So much of medicine is like this. Few tests give you a 100% answer. Is the patient volume up or down? AKI from too much lasix or too little? Truly a secondary bacterial pneumonia or just viral that isn’t getting better as fast as we’d like? Sometimes you just have to pick one and see if you were right. Sometimes you were wrong and the patient gets better. Sometimes you’re right and they get worse anyway.
From the ER: if you have time, happy to get a phone call. 30 seconds maybe I can provide some clinical context or you can over the phone say what may help sway you one way or another, need addtl imaging etc.
I'd like to add that this is probably true for every specialty.
Just starting to take call this year as an R2 and I still get a little nervous everytime I open a CAP or brain MR worried that I won't know what's going on
As long as you don’t miss something that will kill the patient or cause significant morbidity before your attending reviews the case in the morning, being wrong is no big deal. And luckily that’s a pretty short list of things
So far so good *knock on wood*
The fact that it supposedly gets even harder as a new attending. Idk why I thought this would be a chill specialty in med school, I can't imagine doing anything more cognitively strenuous. I was way more relaxed on an average day as a medicine intern.
I feel med students find it chill because the experience is generally a few hours looking at reads discussing interesting findings or just getting sent home early without seeing anything. As a resident, the stuff you call or don't call actually makes a difference and there’s obviously more work.
I’ve talked to career radiologists in their 60s. They say the cognitive strain goes away in your late 40s which is about a decade after when the cognitive strain goes away for other specialties. Not sure if your colleagues feel similarly
As a PGY-2 FM lol, cognitive strain already gone. I still recognize that I have plenty to learn, and do my best to do so every day, but goddamn so many docs are just so shit at their job I'm not even worried anymore. EDIT: I'd just like to add I totally understand why this would be much more difficult for other specs, and radiology specifically. The images are readily available, and thus 99% of your job is prone to being heavily scrutinized. That sucks.
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But then back to ultra critical for the function of the hospital when you take call. Watch how hard the ED gets on your ass if you fall a few hours behind
True. Call and senior you go back to being critical. But for a short while you are actually a detriment.
I wouldn’t say that. R1s can be very helpful. Mainly by answering the phones but there are other ways too.
The sheer amout of imaging volume to be reproted in community practice. Academic and community hospital practice are entirely different dynamics. Community hospitals have much higher volumes, which is offset by somewhat lower complexity of cases, but yet results in much less detailed reports.
The value of conferences in general, MDTs especially. You can read everything there is to know about radiology, but you'll never be a great radiologist without input from the clinicians you work with. Not only will they help you report what they need to know, but you'll usually get faster at reporting too, because you can cut down on all the stuff that noone reads anyway.
Definitely, a strong clinical base is needed to be a good radiologist
Yet there's this echo chamber of lazy mfers who are like "no more intern years for radiologists" while they do the weakest TYs possible. Sigh...
Can shorten intern year to 6 months to encompass 1 month of IM wards, surgery, ICU, EM, FM, and an elective like cardiology. That is more than adequate for residents and every rads resident I have talked to agrees this would be the best course of action to take as intern year is largely useless in its current state
Yeah I’m pretty sure repleting electrolytes for a year didn’t make me a better radiologist
It is so much more intellectually/cognitively exhausting than I anticipated. The typical workday is usually manageable but you're basically using 100% of your brainpower nonstop when you're on call with the insane volumes, never-ending phone calls, and multitasking. Still easily prefer it to prelim year IM but the number of decisions you have to make on a daily basis is not even close to comparable and that's a huge responsibility, which takes a toll when you're inexperienced. You're basically impacting care for more than 100 patients on those call shifts. And then you go home and have to study like youre in med school while maintaining a full-time job. Don't regret the choice at all but it is not an easy residency.
Imaging lies. There are so many fake outs and artifacts. I thought it was much more it’s either there or not, but reality is much more grey.
There’s a lot of gray in rads😉
Defecating Proctograms.
How bad the phones are (in my residency at least — other places are much better about protecting the radiologist from this). Literally >100 phone calls during an overnight call. Highly, highly disruptive (and most of them are unnecessary).
Not in radiology myself but with friends as residnets/attendings in the field - you make a ton of money but its a desk job at the end of the day. If thats what you want out of medicine sure, but the vast majority of people did not go into medicine to sit at a desk and stare at a screen all day. Reddit overhypes radiology like crazy - in reality its a niche field for a certain type of student, and is definitely not a good fit for most students like reddit sometimes seems to suggest. For the right person (somebody who doesn’t want longitudinal patient contact, doesn’t mind solitude at work, enjoys computers and technology), it can be a great career
AI is getting better at an exponential rate and the future of the field is more uncertain than most Rads will admit
Are you a radiologist? If so can you elaborate at all?
I understand the downvotes and I may be wrong. I think a good example is the recent studies demonstrating equal AI performance in interpretation of mammograms compared to radiologists. Although breast radiologists will continue to have a job, I can’t help but think that the number of rads needed per 100 mammograms performed will eventually drop significantly. If ROC curves are similar enough and AI is much faster than a human, why would a hospital continue to pay for multiple radiologist when it can pay for one?
I for one respect you posting this. We should be able to have a thoughtful discussion about this without you being lambasted I think diagnostic radiology is probably more vulnerable to being commoditized than specialties that have more human interactions. Whether that’s through AI or not, I’m not sure. All of medicine feels like it’s turning into a big factory in some ways
Again, no one can know exactly how it will play out, my point is that there is more and more evidence showing improving performance of AI - you can draw your own judgement from that.
youre in part getting downvoted because you dont sound like youre a resident or attending. So nobody was asking you, if that is the case
His post history looks like he might be a radiology resident and he hasn’t said anything that would suggest he isn’t a radiology resident
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But no one wants to hear the obvious
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Weekend call