In 2021, I had the pleasure of reading, and reviewing for this website, Dr. Paul McCoubrie's wonderful book, "The Rules of Radiology." A copy sits on my bookshelf, beside where I am writing this article, and is frequently consulted, whenever I want support, advice or guidance for how I practice radiology, or whenever I want a good laugh.
Now he's done it again! "More Rules of Radiology" has just been published, and, if possible, it exceeds its predecessor in quality and usefulness. The format is the same: 50 short essays on further aspects of radiology, with clear instructions and exhortations to readers as to how we should deal with our working lives, our colleagues, and our patients. Again, the topics are varied and practical, if sometimes unexpected.
Rule #71 / Radiology Reporting Is Like Playing Golf in the Dark. In nocturnal golfing terms, all radiologists hear is occasional shattering glass or annoyed shouts. Your swing may be sound, but you have little idea of where the ball lands. Clinicopathological feedback is a radiological imperative. Without it, all confidence is misplaced. All figures courtesy of John Charlesworth, Paul McCoubrie, and Springer Nature Switzerland AG 2024.
The book consists of 50 short pieces about aspects of modern radiology practice, offering practical insights into how best to do our jobs, serve our patients, and advance our specialty – and with cartoons! I've frequently commented since the 2021 publication that it represents the single most useful text any aspiring radiologist could invest in and absorb.
It's important for readers of this article not to imagine this book is another of those "look carefully at the review areas on a CXR" type of offering. That's good advice, but it's not the sort of guidance offered by McCoubrie (with some exceptions – Rule 61 – Always look at the scouts). He's more interested in much broader, character-developing and skill-enhancing ideas, and in practical advice that may make everyone's life easier and better (Rule 52 – Never wake a patient up, Rule 64 – Never scan the dying).
Some essays concern themselves with how we view ourselves and are viewed by others (Rule 55 – Doctors aren't porters), others with how we interact with referring colleagues (Rule 56 – Don't shoot the messenger). Some are about life in general (Rule 70 – Coffee should be taken black, Rule 85 – You can only eat one breakfast). He even returns to some themes from Volume 1 (Rule 87 – Dress smartly. In the interests of full disclosure, I feel I must reveal that I know Dr. McCoubrie personally, and a better advertisement for a well-cut suit would be hard to find).
Rule #83 / 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.
McCoubrie is not afraid to attempt to inject some common sense and realism into discussion about current radiological shibboleths and fashions (Rule 81 – AI is overhyped, Rule 94 – Structured reporting is overblown). He acknowledges their value but explores some of the aspects of these trends that are rarely spoken aloud. For those essays alone, the book is worth its (very modest) cost.
Rule #88 / Focus on the Gaps. Efficient working entails, in the nicest way possible, racking and stacking your patients. 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.
Above all, this book emphasizes the joy to be had from doing the work of a radiologist in a positive enthusiastic manner (Rule 76 – Radiology should be fun) and offers practical guidelines for how to achieve that state.
The final two rules (Rule 99 – Look after yourself, Rule 100 – It is all about the patient), summarise some of the key relationships and responsibilities of radiologists, above all to the patients we serve, but also to ourselves, in order to keep us happy, productive, safe and fulfilled in what we do.
Rule #92 / 'Order Comms' Must Be Loathed. First, no radiologist should let themselves be 'ordered' to do anything. Second, one-way transmission prevents clinicoradiological discussion. Last, it denies a key perk of the job as there is no physical card to rip up. Wait until they've left the room then savour the sensation all on your own.
"More Rules of Radiology" is an indispensable guide to those in radiological practice, and an invaluable primer for those in training or aspiring to enter our world. It's also very funny (perhaps I should have led with that selling point!), and spending a few minutes daily reading one of the rules could go a long way to fulfilling Rule 76 (see above). Buy it, enjoy it and try to live by it.
Prof. Adrian Brady is past president of the European Society of Radiology and a clinical professor in radiology at University College Cork (UCC), Ireland. He was president of ECR 2023.
