February 17, 2023

Taking Decisive Action to Overcome Mediocrity*

Kenneth J. Keller, MD, FACR

Mediocrity is ubiquitous. Whether we are shopping, working, driving, dining or having a phone conversation we are frequently confronted by those who don’t know, don’t care, don’t know that they don’t care or don’t care to know the difference.

It’s not so much that they don’t like us or wish we’d get lost. It’s more that they just don’t get it. Or they’re just obtuse or too dense to fully understand how to do it or get it right (whatever “it” is).

We’ve probably encountered this in our personal lives as well and perhaps even felt this way about certain referring or clinical colleagues. However, we should all periodically self-evaluate to make sure others would not similarly characterize us.

After finishing residency nearly three decades ago, I’ve continuously maintained privileges at one institution. I’ve also experienced working within various practice models including an independent private group, locums, teleradiology, and most recently, hospital employment. Regardless of our practice situations, we should always encourage each other to avoid the “M” word — mediocrity.

It’s so easy to start sliding! Picture this — we’ve just been on call, and we are so tired. We’re not feeling as sharp as usual and just want to finish and get home. We don’t want to take the time or expend the extra effort to be as ambitious and persistent as our patients and referring physicians deserve.

We all know the drill — abdomen/pelvis CT for abdomen pain. We go through our standard search pattern and discover an incidental pulmonary nodule. Since most of us read from a PACS workstation, we expect comparison studies to automatically load onto the comparison monitor, and when we don’t see a comparison, we assume there is none.

However, we need to be smarter than our machines and remember that they cannot think and will not load the 4-year-old HRCT at the bottom of the prior exam list. For any number of reasons, we do not look through that list, so now we cannot confirm stability. And, instead of finding the “comparison” that confirms stability, we recommend a follow-up CT according to incidental finding society guidelines and feel like we’ve done our job. Sound familiar?

Or consider a different scenario: PACS workstations are pervasive and well understood by virtually all of us. Likely we’ve all seen a difficult case remain on the work list for hours or until the next day because everyone seems to skip it. Finally, one of the rads who always seems to get things done picks it off and then the case gets read. This should not happen, but of course we know it does.

Or maybe it’s something unrelated to interpreting images and more about style or lack of consideration. It’s been a busy day and we decide that we’ve had enough. So, we ask our colleagues if it would be ok if we left early as we’re not feeling well, have an appointment or we’re just tired. But this puts them in a tough spot, because it’s hard to say “no” to an associate.

Over coffee or in the lounge, we frequently talk about lack of personal responsibility across America, and yet do we ever find it creeping into our workplace? If everyone did what we are doing, would the entire group be better off?

We should always be vigilant, periodically self-examine our own habits, and be ready to take decisive action to avoid mediocrity.

* Originally published online in Diagnostic Imaging, August 2012.