Wet Read: What kind of thinker are you?

“The transition between competing paradigms cannot be made a step at a time, forced by logic and neutral experience. Like the gestalt switch, it must occur all at once (though not necessarily in an instant) or not at all.”

—Thomas Kuhn

Radiologists have to incorporate vast amounts of data into a report. Hopefully, that report makes some sense to someone along the way, and also (hopefully) translates into proper diagnoses and improved patient care.

Those of you reading cross-sectional imaging studies know for a fact that your pile of work is getting deeper and deeper, as our CT and MR scanners crank out bigger, thinner, and more widely varied data sets. 1000 images? No worry. So there are a finite number of hours in the day, a finite amount of time to review a case and report it, and an almost infinite number of studies to read. You sit down and furrow your brow and look at those dots and make a picture and then contemplate what it means. Think, and talk.

Talking, I’ll address later. So, what kind of thinker are you?

A recent book, Thinking, Fast and Slow, by Daniel Kahneman, has been widely quoted about this topic. I’ve worked with a number of really great radiologists over the years in 2 distinct schools. In Group 1 are the fast thinkers: the Gestalt, or knee-jerk, or rapid assimilation or whatever you want to call them thinkers. They look at the images, take a deep breath and rapid-fire you their findings and significance. You can almost hear the gears spinning in their heads. Wow! It’s impressive to watch. How the hell did they do that? It isn’t a coffee thing, either. Well, maybe sometimes that contributes, but they just work in that fifth gear.

In Group 2 are the slow thinkers: Show them a case, listen to the silence for a few minutes, walk down the hallway to get some coffee, maybe talk with the techs in the hall, wander back, and then hear the case discussion. You get their thoughts presented carefully and succinctly. All the items are present, just delivered way, way more slowly and methodically.

I can appreciate both styles. I admire Group 1 practitioners because that turbo speed thing has to be amazing to possess. I admire Group 2 stylists because the thoroughness and the carefully laid-out logic is typically flawless. Both intimidate me. We had two chest radiologists at UVA during my training period who were at both ends of the spectrum. I loved watching them in conference, approaching the cases entirely differently and coming to (almost invariably) the same conclusion. It was awesome. Oh, to be that smart, eh?

Keep doing that good work. Mahalo.