A Day in the Life of a Radiology Registrar
I’m currently an St3 in Radiology and I’ve noticed that things have changed for me since we have had a new batch of trainees join us. Now there are more people junior to me that expect me to know something! I’m a bit daunted at this prospect, but try my best not to show it. Being an St3 puts me in a position where I’m not that senior…but at the same time, I kind of am. I can just about get away with saying I need help with something, but for how much longer?
At some point eye brows will be raised if I get stuck with something trivial. That’s not to say I haven’t made any progress, I obviously have. I must have! I definitely feel more confident when talking to senior clinicians, or at least sound it. I don’t quiver when I hear a registrar or consultant from another specialty asking for my opinion. The other day I even had an St1 watch me do an ultrasound. She seemed to marvel at the ease at which I was able to take pictures of the kidneys…or at least I think she was marvelling at my skills…
Anyway I’ve arrived and its 9:00am, I’m on time, but to be honest, today it doesn’t really matter. I walk into the department and I’m almost embarrassed to be walking in at this time as there is already a load of clinicians running around the department desperately trying to get their patient first in the scanner. I walk swiftly past them trying to look like I’m a man on a mission just in case they recognise me and think they can ask for a signature. It’s like trying to work through a mob of fans except I’m not a celebrity and they don’t want to take a photo with me to stick on their FB (that’s Facebook…not foreign body btw).
I’m doing CT reporting in the morning. My consultant won’t be in till about 930am and the CT scanner is still about to fire up, so there won’t be anything for me to do for a while…Basically I still have time for a coffee.
I drop my jacket and bag into the registrar room. I’m not even sure why I bring a bag to work anymore. It sometimes carries my lunch when I can be bothered to make it, but otherwise all I really need is a pen for the paparazzi outside.
I’ve got my coffee and fire up the computer. I check my pockets and make sure I do actually have a pen. It would be annoying to forget the only thing I really need these days. When we move to a paperless request system…I won’t even need that! A pen to a radiologist is like ‘guessing tubes’ to a medic or a colouring book with assorted crayons for an orthopod.
The computer is on and I’ve managed to get the first set of scans up. It’s a CTPA looking for a pulmonary embolism. Thinking back now, I can’t remember the last time I saw a pulmonary embolism. You would have thought that protocolising something like that would make our diagnostic yield of pulmonary embolisms higher, but it seems that the Wells scores serves a very different purpose to what its meant to these days. Anyway, unsurprisingly its negative for a pulmonary embolism. I’d love to see a pulmonary embolus again. Next time I see one I’ll be declaring it on my Facebook status so the whole world can know – ‘Donnie has seen a PE!!! WOW!!!!!’
I spend the next few hours working through and issuing provisional reports on the CT heads, CTPAs, CT abdomens and I almost don’t notice the consultant walking in. It’s quite funny as he’s come in and started to complain about the parking in the hospital. He spends the next few minutes complaining and I wish I could tell him that if he bothered turning up on time, he’d find a space…the same way I do every day of the week.
The next few hours are quite enjoyable. I really like working with this consultant. He’s always in a good mood, really chatty and funny (but to clinicians he’s a bit different). Also he’s an incredible radiologist. He will literally open the scan up on two screens, get them linked to each other, change one set of images to lung windows and the other to soft tissue. He then clicks the loop button and sits back watching the pictures run by. Within two minutes he tells me everything I’ve missed and then re-writes my reports. Its really amazing to see.
It eventually gets to 13:00pm. I thank the consultant (for re-writing my reports and reminding me why I’m still a registrar) and walk out towards the registrar room where my lunch is waiting for me. I can almost taste it now, microwaved pasta…lovely. I’m suddenly interrupted by a clinician who has recognised me as a ‘radiologist’.
‘ Hi, you’re a radiologist right? I need to get this urgent scan protocolled…please?’
He shoves the request card into my face and I’m startled. I’m annoyed that he’s eating into my…eating time. I look at the form and it’s an ultrasound of the kidneys for a rising creatinine. It isn’t urgent enough to stop someone from getting their lunch! Why on earth would he do this?!
‘Could we get it done in the afternoon session?’
I take the form from him and tell him that I’ll do it in the afternoon since I’m doing ultrasound later anyway. I also explain to him that this is in no way urgent and he could have easily got this protocolled after lunch and it would have ended up on my list. There is no need to randomly stop someone on their way to eat. I feel silly to make a big deal about it…but why do you think I do this job?! A designated lunch break is one of my many perks and it’s not my fault other people have opted for jobs where they’d be lucky to get a sip of water in the day. I don’t think he cares, he has got what he wants…
I spend my lunch time talking to the other radiology registrars relaying interesting interactions with clinicians, scans and talking about what was on TV last night. It seems ‘The Great British Bakeoff’ is a must see in the radiology department. It’s nice to be in one training scheme for the duration of my training. I really get to know my colleagues well and luckily we all get along.
It’s now time for the afternoon session and I’m doing the ultrasound list. I skim through the cards and its a lot of ‘deranged Liver Function Tests- please exclude pathology’ and ‘raised creatinine- possible obstruction?’. In amongst this there are also ‘Right iliac fossa pain, raised WCC count – possible appendicitis’ and ‘bilateral leg swelling, known cardiac heart failure – rule out DVT’. I really don’t understand what has happened to the world these days. There was a time, when pain in the right iliac fossa and a raised WCC did not mean ultrasound. It meant…do something! Bilateral DVTs? How often does that even happen? Surely there should be a Wells score…but then again…maybe not… no one seems to know how to actually calculate one anymore!
It’s amazing how other specialties think that ultrasound doesn’t count as patient contact. Often the patient is worried, talkative, annoying or rude in the same way they are on the wards. They watch the screen in anticipation of what the news might be, and annoyingly ask you what you think is going on as soon as you’ve touched them with the probe! Today I have a clinically obese lady with abnormal LFTs. I wonder why her LFTs are funny…it might have something to do with the layer of insulation I’m going to have to stick this probe on. I actually have to peel back layers of fat to get to where I assume her liver would be. I manage to get the probe in and the layers of fat droop back onto my hand. I have to use my strength to push it all back but it still engulfs it. My hand starts to feel damp in there and I can’t actually see it any more…I think she must be sweating…or maybe she’s digesting it.
I’m feeling a bit ill. I do the best I can and surprisingly (!) she has gallstones and she has a fatty liver. When I finally get my arm back the probe is covered in some kind of crusty material, my hand is drenched and smelling like it is in need of being in an incinerator…this is too much patient contact for my liking.
Having washed my hands, I continue with my list. There are some interesting things today. I manage to see a duplex collecting system which is causing the patients recurrent episodes of infection, an incidental finding of a 4cm ovarian cyst, liver lesions that look like metastasis, a lipoma, no DVT and a fair bit of ascites. All in all a great afternoon.
I finish writing my reports and walk past a poor Foundation doctor trying to cannulate a patient pre-scan in the corridor and another running around trying to find a consultant to sign off a MRI request. Looking at the time on my watch its 16:55…no chance. I hear their bleeps go off almost instantaneously… I look down at my belt where my bleep used live not so long ago… I don’t miss it at all:-)
On my way out I end up bumping into the radiology registrar who is coming in to start their on call. I also take a mental note to prank call him later- pretend to be a clinician asking for a really stupid scan like an urgent ultrasound toe…that’s always a good one.
Tomorrow I’ll be doing some Flouroscopy in the morning, MDT at lunch and MRI in the afternoon…I’ll tell you lot about it soon….