Dr. Patricia Rhyner Interviewed by Dr. Xin (Cynthia) Wu

First and foremost, what’s your advice for young professionals just entering practice in terms of making sure you become a good clinical radiologist?

Well, one of the biggest complaints about radiologists is that we haven’t thought about the clinical question and that we’re just running through a worklist while the referrers really want more guidance. I’ve always said the best doctor in the room is the radiologist, because we know the whole body. I finish a dictation by saying “no explanation for headaches” if the indication was “headache” or offer guidance for the next step if I think something else might help make the diagnosis.

While we need to know the intricacies of radiology and MR and CT physics etc, being in tune with non-radiology journals and literature is really important. We must focus on reading not just radiology, but texts and journals from neurosurgery, ENT, neurology, neuro-ophthalmology… Of course, this takes time and can be a five or ten year project, but can be tailored to your practice. For example, if you see that your practice has a lot of pituitary surgery referrals, then you not only immerse yourself in the anatomy and imaging findings of the pituitary and sella, but also investigate what the surgeons may be looking for, now that the surgical techniques have changed, and they’re even going into the cavernous sinus. So let’s pick out two or three neurosurgery journals and papers to learn what we need to tell them about the cavernous sinus.

I have always felt it important to be one or two steps ahead of our referrers. For example, as soon as they started performing endoscopic sinus surgery, I learned the approach, knew the complications, and knew what they were looking for. While all this may sound overwhelming to a junior attending, I believe it is an important goal to keep in mind. Be patient, watch what’s happening medically in your specialty, and then try to stay current so you can offer valuable advice to your referring colleagues.

Ultimately, there’s so much that we radiologists have to understand and know. I also know that there are some things that I just can’t memorize. So, I keep a set of notes and “go-to” reference articles on my desktop that I will refer to every time certain questions comes up. You have to know how to pick and choose your battles–some things that you want to know and remember and understand and other things that you will just have to look up every time. One example is differences between basilar invagination, platybasia etc. I keep a reference for all the normal angles and distances.

What’s your advice for people who are becoming academic radiologists and trying to balance busy clinical practices with teaching well at the PACS?

The biggest mistake is trying to cover too much in a brief readout. Say you’re reading a trauma head with a first-year resident, and there’s so much for them to know. What’s intra-axial, what’s extra-axial, are there changes in ICP or herniation… Ultimately, it’s too much for them and it’s too much for you to cover in that short amount of time.

Don’t try to teach a chapter worth of knowledge with each case. Choose one thing that’s important. In this example, maybe I’ll say, let’s talk about intracranial pressure. What is the normal ICP? What are imaging findings of increased ICP? In your head, you have to break things down into tiny topics so you can start small, know your audience and their level, and help them make incremental gains in their knowledge base.

When I can, I also like to establish a personal connection with the trainee. Everyone has a story, and these relationships are important to me. The right question gives the trainee a chance to tell me if they are encountering a crisis in their life and might need more understanding, support and compassion in that moment.

What are your recommendations on how to be a good speaker or lecturer?

Speak slowly. Don’t run sentences together. Make a pause between sentences. Have limited goals of what you want people to know. I use very few word slides and I can spend an hour on the analysis of one image. Use your pointer and again, speak slowly. In the end, you’re the only one who knows you didn’t finish your talk. Right? If you try to rush through the last 10 minutes, everyone’s uncomfortable, and nobody’s paying attention to the contents. If I realize I’m about to run out of time, I’ll say, “I have two minutes left. I’m going to stop here. These are the three things I hope you’ve learned from my talk.”

Of course, that means you’ll really need to know your talk.

What is your advice for young professionals who are hoping to get more involved in ASNR?

This answer is possibly controversial. Have patience. I see people so into building up their CV when it’s way too early. Right out of fellowship, a lot of people want to be on committees, but you may not understand how committees work and what you’re getting into. The societies want your energy and they want your thoughts, but you need to invest several years in learning the culture of the society and where your efforts might be needed and best spent.

The arc of an academic career is long. Mine was almost 35 years. So, the first five years for me was learning to be the best neuroradiologist I could be. Once you learn your craft, you might realize, “Wow, I don’t even want to be on that committee. My interest is actually somewhere else.”

Early in your career, you’re often encouraged never to say no—but there are probably some things you should say no to. For example, a time-consuming committee that sounds prestigious but you’re not really so interested in.  It is normal to be afraid of disappointing people or worry that opportunities may not come again if you say no, but there will be many opportunities in academics for your endeavors, so make each one meaningful.

What is your advice regarding focusing your energy on research and publications?

When it comes to writing academic literature, the biggest time sink with the smallest return is a book chapter. However, I always said yes if the chapter was on a topic I didn’t know much about. Of course, my startup time is going to be long because I’m going to have to read all the other chapters and articles out there on this topic. Once you’ve done the background work, the writing becomes much easier, and now you’re the expert on the topic.

I’m also big on double dipping–if I write a chapter, all the images will go into a PowerPoint, and now I have a lecture presentation. Once I’ve been immersed in literature on a certain topic, I almost always found an interesting, intriguing question that nobody had ever dealt with, so that was my next article, my next project. After all, the goal is not just to get that publication. The goal is to continue to build the infrastructure and foundation of knowledge, but at the same time, it helps to be efficient.

What’s your advice on effectively mentoring a junior trainee?

I think we try to mentor too early, when we may not be prepared for it. And I also think the concept of “mentor” is over-used. Half the time you are just giving advice! I’m aware that this is not a popular idea. My vision of mentoring is a close relationship over a long period of time. In order to be a good mentor, you have to have a bigger vision of the world and the environment your mentee is in. Assuming you can mentor someone is a big responsibility.

There may be room for more directed mentorship at an early level—for example, a resident may be more suited to advise a medical student about the residency application process because that experience is fresh on their mind, but they are not the right “mentor” to direct the student on their overall life and career goals.

For this reason, it is especially important to know what a mentee needs or wants to get out of the relationship. Often, when people come to you for mentorship, they don’t have a question yet. So, you need to start by figuring out what their goals are and then you can determine whether you are the right mentor for this person and their needs.

For people I mentor, I want to stop the gamesmanship. Getting into college is kind of a gamesmanship, getting into med school, getting good evaluations etc, but now this is your life!  Tell me what you really need and want and what’s true. Be sincere and honest with yourself and your mentor.

What, if anything, would you change about your career?

For the first 15 years of my career, I was sometimes hot-headed. I saw needs but was in an institution that didn’t listen. So, in order to get attention and be heard, I had to be loud and often came across as the bad guy. I was frustrated! In retrospect, I may not have had the institutional knowledge on why things were done a certain way, and may have inadvertently hurt people while speaking out in frustration. If you find yourself in a similar situation, it could be worth-while to take a step back, assess your boundaries and needs, and decide if the environment is the right place for you.

The other thing I would change about my career was when I was put in a leadership position—as a woman over a group of men—without adequate preparation. That time in my career was difficult and painful, as I accepted a position without preparation or even support. There’s nothing worse than taking a leadership position and failing. In retrospect I was not ready for a leadership position and I should have said no to the offer. If an institution is smart and supportive, they will invest in you and make sure you get the training needed to lead before asking you to take that responsibility. You should be aware that such opportunities may come again when you’re more prepared for them. After all, an academic career is long and often cycles, so take a step back, know your limits, and progress at your own pace. Offers may be flattering, but be sure you are ready and there is institutional support before you accept an important leadership position.