0:01

All right.

0:01

Do not read when tired. Well, this gets to the large number

0:04

of cases that we read

0:05

and the fact that we make more mistakes

0:07

at the end of the shift.

0:08

We make more mistakes when we have longer shifts,

0:12

12 hour shifts or 16 hour shifts.

0:14

There's a reason, in part why we have duty hours

0:17

restrictions on the, uh, young people who are in training.

0:22

Kind of interesting to me

0:24

because, um, on our weekends, we often will read our cases

0:29

from 7:00 AM to 11:00 PM with one attending, um, like me,

0:34

who's, you know, Medicare age.

0:37

And yet at the eight to 10 hour period,

0:42

I get switched out to a new fellow

0:44

because they have duty hour restrictions

0:47

and they shouldn't be working that many hours.

0:49

So, so the old guy who's reading for 16 hours

0:54

has to keep going as the attending,

0:56

but the trainees who are in their thirties

0:59

and twenties, they get to have the break at eight hours

1:04

and have someone else come into 'em.

1:05

It's a little paradoxical if you ask me. So don't retire.

1:08

Most misses occur at the end of shifts on busy shifts, uh,

1:12

longer shifts with tired eyes, as you heard from Dr.

1:16

Ksky. So to the extent that you can have double the number

1:20

of people on the weekends, which is not all

1:24

that attractive for most practices, um, reduce the length

1:28

of shifts, um, it's important that you take breaks.

1:31

I'm a very avid napper,

1:34

and I don't feel very, um,

1:39

very much fatigued when I wake up from a nap.

1:41

I feel rejuvenated, so it helps me to have

1:45

that break in the middle of the day.

1:46

Uh, caffeine. Yeah, it works.

1:49

Shorter shifts said that

1:50

before, restrict the number of cases per shift.

1:53

Well, you know, we are subject to emergency rooms and storms

1:58

and ice on the highways in the emergency rooms, um,

2:04

riots in Baltimore.

2:07

So, uh, it's hard for us to adjust the volume,

2:10

but there are some practices, I believe used to be

2:13

that Mayo Clinic had a certain number of cases that you had

2:16

to read each day, and that was it, and they let you go home.

2:20

So there is some justification for that.

2:24

So factors associated

2:26

with the diagnostic errors at a large tertiary center.

2:29

Diagnostic errors were associated with shift volume,

2:32

weekend interpretations,

2:34

but not how long it took you to read the case, um,

2:38

or if you had a trainee.

2:39

However, in multi-variable models,

2:41

diagnostic errors was independ independently associated

2:44

with interpretation time, um, odds ratio 1.18,

2:49

shift volume 1.27, and working on the weekends 1.69.

2:54

So it's obvious that we as radiologists should just say

2:57

that we don't work on

2:58

The weekends and put every, all the cases to the, uh,

3:02

I'm joking obviously to Monday,

3:04

but, um, weekend reads, which generally tend

3:09

to be longer shifts

3:10

because it's usually a reduced number of people

3:13

with larger number of cases, have more errors,

3:18

more, this is the article on, on off hours interpretation

3:22

of body cts

3:23

and overnight assignments on the basis

3:26

of subspecialty review.

3:27

Clinically important, off hours body CT interpretation

3:30

errors occurred more frequently, overnight,

3:34

and in the latter half of assignments

3:36

with more radiologists having worse error rates at night

3:39

compared with the day that element of fatigue.

3:43

So one other, uh, tip here about reading when tired is, is,

3:48

you know, try to reduce your distractions.

3:51

So some people will have clerks

3:54

or something to answer the phones

3:55

and to deal with some of the issues.

3:58

We in, in, at Hopkins don't have to deal

4:01

with a lot of the patient issues.

4:02

We have residents and fellows who are dealing with protocols

4:05

or interviewing the patients.

4:07

We can just sort of focus on the images

4:10

and maintain that high sense of accuracy.

4:15

So nonetheless, I can't tell you how many times

4:19

in my 35 years of practice I've been on the drive home

4:23

and I said, oh my God, I forgot about that thyroid nodule

4:26

that was in that one case.

4:27

Oh, I have no idea which patient it is. No idea.

4:30

I I just hope they read the body of the report,

4:33

which is not necessarily a given with some clinicians.

4:37

Um, if you've got patients who are oblique

4:40

and abnormal positioning, I really hate this

4:41

because an oblique image is really harder,

4:44

much harder for me to interpret.

4:46

And, uh, even spending the time to try

4:49

to reorient the image, it, it's lengthy, it,

4:53

it's will disturb me and that's a distraction for me.

4:56

I'm more likely to make errors on abnormal positioning

4:59

or non-standard pulse sequences

5:02

or obviously if you have any equipment malfunction.