By Dr. Paul McCoubrie, AuntMinnieEurope.com columnist

September 5, 2018 -- Hopefully many of you will recall my previous two articles from October 2015 and February 2013 about simple rules of radiology -- the uber-truths that are the very essence of our dear specialty. Well, it's taken nearly three years, but I've now come up with another batch of rules. And remember, you must obey the rules ...

Rule 1: Radiology is extrapolating from a screen grab
If life is a box set and illness is a single episode, radiologists are left to infer the plot from a single screen shot. This explains why radiology is so damned difficult sometimes.

Dr. Paul McCoubrie
Dr. Paul McCoubrie is a consultant radiologist at Southmead Hospital in Bristol, U.K.

Rule 2: Coffee should be taken black
Coffee is the lifeblood of our radiology, our dominant fuel source. Thus the Bean should be treated with total respect. Never ever syrup, sugar with caution, warm milk only in extenuating circumstances.

Rule 3: Radiology reporting is like playing golf in the dark
Your swing may be sound but you have little idea of where the ball lands. Clinico-pathological feedback is a radiological imperative. Without it, all confidence is misplaced.

Rule 4: Never report "no change"
It is a supremely unhelpful radiology report. It is only permitted in one specific circumstance -- when reporting an x-ray of a child looking for swallowed coins.

Rule 5: Always report in date order
The oldest studies get done first, irrespective of their complexity, image quality, or indication. Cherry-picking is the mark of a lazy and selfish radiologist.

Rule 6: Beware the radiologist with a zero error rate
It either means they are: (a) perfect, (b) doing no work, or (c) being dishonest. Given (a) is impossible and (b) is unlikely, it means that (c) must be true.

Rule 7: Interventional radiologists don't need to care
Technical ability always trumps empathy and communication skills. The heart of an interventional radiologist doesn't need to be in the right place, but their lines should be.

Rule 8: Radiology should be fun
Radiologists are medicine's dolphins, frolicking in its warm waters. If it doesn't feel like fun, then you need a holiday. Failing that, move to a hospital where you are valued.

Rule 9: There is no such thing as a "naturally gifted" radiologist
Natural talent is a myth. Show me a talented radiologist and I'll show you someone who works their socks off. Show me a substandard radiologist and I’ll show you one who opens neither books nor journals.

Rule 10: Introduce yourself
Just because you are a radiologist doesn't mean you are above common courtesy. Greet patients and staff by turning to them, smiling, fixing eye contact, and proffering a brief but firm handshake whilst saying "Hello, my name is __". Do this every time. Especially the last bit.

Rule 11: Trust in chronometry
Those who take twice the time to report their scans are half as good. The corollary isn't true. Those who take half the time to report their scans are also half as good.

Rule 12: Be cautious about 3D reconstructions
No self-respecting radiologist would ever use them for primary diagnosis. And, no, they aren't particularly interesting or clever either. Generally they are mere pretty baubles to keep the surgeons happy.

Rule 13: AI is often overhyped
Whenever anyone says artificial intelligence (AI) will replace radiologists, you have my personal permission to beat them with their own shoes.

Rule 14: Do the simple things well and often
If you are courteous, honest, well-presented, organized, methodical, and work with a slick team in a clean environment, then you are > 90% of the way there. Heroics are rarely necessary and paradoxically unhelpful.

Rule 15: Show yourself
An invisible colleague is an annoying colleague. Beavering away in a quiet corner mustn't be the default. If you can't be found easily, you aren't doing your fair share. Step out of the shadows and pull your weight.

Rule 16: Don't criticize colleagues
It is unwarranted -- they are usually trying their hardest. It is unhelpful -- a knife in the back helps no one. It is destructive -- it sours relations. A good radiologist leads by example and encourages others.

Rule 17: You can only eat one breakfast
Quality of life and happiness barely increase as income rises above 50k euros. And yet monetary squabbles are a common cause of rancor between radiologists. Rise above this. If you are in it for the money, you are in the wrong trade.

Rule 18: You will learn to hate voice recognition
Yes, yes, yes -- voice recognition has brought some benefits. However, it turns most radiologists into expensive secretaries. And nothing in your working life is quite so annoying, quite so often.

Rule 19: Dress smartly
The vogue for dressing down is to be resisted. You are a doctor, dammit; dress like one. The less formal your clothes, the less respect you'll get. If you look like a scruffy overgrown teen, don't complain when you are treated like one.

Rule 20: Focus on the gaps
Time taken to report a scan or perform a procedure is irrelevant. It is a statistic, not a quality measure. Some scans take longer. Some people take longer. The time wasted before and between scans or procedures should be the focus.

Dr. Paul McCoubrie is a consultant radiologist at Southmead Hospital in Bristol, U.K.

The comments and observations expressed herein do not necessarily reflect the opinions of AuntMinnieEurope.com, nor should they be construed as an endorsement or admonishment of any particular vendor, analyst, industry consultant, or consulting group.


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