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PII: S0363-0188(18)30064-1
DOI: https://doi.org/10.1067/j.cpradiol.2018.03.001
Reference: YMDR614
To appear in: Current Problems in Diagnostic Radiology
Cite this article as: Timothy Alves, Monica Kalume-Brigido, Corrie Yablon,
Puneet Bhargava and David Fessell, The Nine Habits of Highly Effective
R a d i o l o g i s t s , Current Problems in Diagnostic
Radiology,doi:10.1067/j.cpradiol.2018.03.001
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Title: The Nine Habits of Highly Effective Radiologists
Authors: Timothy Alves MD1, Monica Kalume-Brigido MD1, Corrie Yablon MD1, Puneet Bhargava
Author affiliations:
1- University of Michigan
2- University of Washington
Corresponding Author:
Timothy Alves MD
talves@med.umich.edu
Acknowledgements: None.
Disclosures: None.
Abstract:
development delineated first seven, then ultimately eight, habits of highly effective people with
applicability to all professions.1 This article describes the eight habits in specific relation to the
radiologist, and proposes a ninth habit to help one bring a positive and centered approach
Introduction:
desired result. In radiology, our desired result is of our choosing and includes goals such as
providing excellent clinical care, having a successful practice, teaching effectively, advancing
Covey’s first three habits are designed for the individual to achieve independence in
one’s quest for effectiveness. Covey’s habits four through six focus on cultivating beneficial
interdependence. Covey’s seventh habit is about continual improvement and the eighth habit is
to make the leap from effectiveness to greatness. We propose a ninth habit, ‘Cultivate
gratitude and mindfulness,’ which supports the eight habits by helping one bring a positive and
Below, we tackle the habits one by one, with special emphasis on how they relate to the
life of a radiologist.
Habit 1 - Be proactive:
Often we are in a reactive state, bouncing from urgent task to urgent task. Habit 1
encourages us to be proactive – to anticipate and solve problems before they arise, to act with
conscious intention rather than to react. As the first habit, the idea of acting with purpose,
rather than taking a defensive reactionary stance, sets the tone for the approach to the
remainder of the habits and how they can be implemented into one’s professional and personal
life.
For example, one can plan ahead and create a daily and weekly schedule to help
maximize effectiveness. One can anticipate issues with tomorrow’s procedural cases by
previewing them the day before. When writing a manuscript or grant, one can anticipate
reviewers’ concerns and address them up front. When making management or leadership
decisions, one can anticipate possible opposition and discuss plans with the potential
Imagine a scenario in which a procedural ‘near-miss’ almost harms a patient and one
believes there are system factors at fault. Applying habit 1, one could proactively address the
situation by warning others in the group about the potential hazard and designing a quality
improvement project to investigate and address the issue. In radiology we rely on many
systems to keep our patients safe. A pro-active review of such systems, such as radiation dose
monitoring during CT procedures, benefits not only patients but our respective institutions and
Habit 2 is about setting goals, both big and small. It can be helpful to divide goals into
different facets of one’s life (professional, personal, physical, financial, etc.) and create short,
medium, and long-term goals. iSMART (important, Specific, Measurable, Actionable, Realistic,
Time limited) goals can aid effectiveness and ideally focus on important topics, rather than goal
setting around trivial topics to give the illusion of progress.2 Writing these goals down and
having a system to periodically track & review them and celebrate successes can aid success.
Keeping such goals in a visible place can serve as a constant reminder of what one hopes to
For example, a radiologist’s goal may be to learn more about certain subject matter
through CME courses, or to roll out a new service line such as 3D printing. Such goals serve not
only the individual but also his or her practice group, institution, and of course patients and
their families. Similarly, one can obtain a certificate in leadership through the RLI or AAPL or in
the business aspects of radiology such as finance. By having specific learning and networking
goals in mind, one can also maximize the value of attending national meetings.
A young radiologist in their first job, no matter the setting, will often be overwhelmed
by the myriad possibilities for their career. Applying habit 2 and setting appropriate goals can
help the junior radiologist make decisions about how they spend their non-clinical time, be it
learning the business of radiology to become a practice leader, developing a research niche,
Are “first things” the most urgent or the most important? Who decides? Covey proposes
‘urgent vs non-urgent’ (Figure 1). It is easy for much of our time to be wasted on tasks which
are urgent but unimportant – many emails, phone calls, and other interruptions. Urgent and
important tasks often need to come first, but it is most effective to spend the bulk of our time
Where one spends one’s energy and time should align with the goals set with habit 2.
Which tasks in a practice could one delegate to support staff in order to increase efficiency and
maximize the time and energy expended? This is important for all radiologists, who may have
different roles (clinical, administrative, educational, etc.) and multiple demands on their time.
Applying habit 3, one could categorize their to-do list based on the four quadrants, focus on
The first habit for cultivating interdependence reminds us that life is not a zero-sum
game. It is possible, and preferable, that both parties see the outcome of an interaction or a
solution to a problem as a win. In order to ‘think win/win,’ one must be able to put one’s self
into other people’s shoes and learn what winning means to them. This ties in to habit 5,
improvement projects when trying to get ‘buy-in’ from multiple groups of stakeholders or when
proposing a change in the call or rotation schedule with colleagues. The goal in working with
others should be to find mutually beneficial solutions that ultimately advance patient care.
Adopting a win/win mindset will lead to better outcomes for all parties involved, and also make
viewpoints as a requisite for creating mutually beneficial relationships. This can be useful in
discussions with clinical colleagues, support staff, and with our patients. Seeking to understand
the other first, and checking in with them to be sure we have it right (reflective listening), can
go a long way toward increasing mutual understanding and mutually beneficial relationships.
This principle is important to remember in conversations with referring physicians and support
staff, especially during stressful interactions where emotions may run high. This is a
fundamental approach for all interactions. After deeply and fully listening to another, one can
improve turn-around times. Until one fully understands why they would make such a request
and the pressures they face, one cannot begin to address the issue and find a mutually
beneficial solution. In order to think win/win, one needs to understand what winning means to
Habit 6 is based on the principle that the whole can be greater than the sum of its parts.
When working together as a team, we can achieve results we could never reach working
independently. The goal is to create an environment of creative cooperation amongst all levels
of staff in a practice. How amazing does it feel when things flow smoothly, with each person
doing his or her part for the greater good? If we recognize and appreciate individual
contributions to the team when things work effortlessly, it creates momentum and positive
For example, if one were tackling a quality improvement project to decrease MRI wait
times, one could address the problem in an interdisciplinary manner involving referring
clinicians, technologists, and clerical staff in a way that would accomplish more than any one
person ever could. This approach likely will take longer and involve more short term
frustrations. However, the payoffs can be larger, more sustainable, and ultimately serve more
reinforces the concept of continuous and never ending self-improvement through the analogy
of a saw. Blades dull and rust over time, as do our skills. By periodically ‘sharpening the saw,’
we can stay sharp and effective in reaching our goals. In addition to maintaining clinical skills
conferences, one can continually hone their non-interpretive skills through participation in
leadership and personal development courses, Lean and process improvement methodologies,
and Maintenance of Certification (MOC) projects. One can seek mentorship and ultimately
mentor others as a way to ensure accountability and promote progress in one’s career
development.
Effectiveness is about producing results, but true greatness lies in the impact we have
on others. Covey later added this 8th habit to encourage people to find their passion, to which
they could then apply their newfound effectiveness. The most important point about finding
one’s voice is not so much that the voice has to be unique or powerful, but that it is truly and
authentically one’s own. What is your voice as a radiologist? Is it being a practice leader? An
outstanding clinician? A quality and safety expert? Teacher? Researcher? Knowing and
nurturing one’s voice taps into the energy and excitement felt while learning, growing, and
contributing, and helping others do the same. Paying it forward by mentoring others and
helping them to find their voice is equally important to achieving greatness. Mentoring can be
We propose this ninth habit as a method to stay grounded and positive during our never-
ending quests for professional and personal success. Gratitude represents “a life orientation
towards noticing and appreciating the positive in life.”3 Studies have shown that gratitude is
related to adaptive personality characteristics, positive social relationships, and physical health
(especially stress and sleep).3 When cases are piling up and the phone is ringing off the hook,
how much better could your day be if you took a moment to express and really feel gratitude?
Studies have shown that simply writing down three things you are grateful for 2-3 times a week
awareness of our thoughts, feelings, bodily sensations, and surrounding environment with an
attitude of acceptance without judgment.”5 Mindfulness has been shown to increase positive
emotions, decrease stress, improve memory and attention skills, and enhance relationships. 5
Mindfulness has been specifically shown to help health care professionals cope with stress,
connect with their patients, and improve their general quality of life.5 A common mindfulness
accepting whatever thoughts and feelings arise and letting them pass without judgment. This is
Much has been written recently about the epidemic of physician burnout, and
radiology is no exception. Cultivating gratitude and practicing mindfulness are simple ways a
Conclusion
Stephen R. Covey’s eight habits of highly effective people, and our proposed ninth habit,
focus on principles that aid personal and interpersonal effectiveness and mastery both at work
References
1. Covey SR. The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change.
2. Duhigg C. Smarter Faster Better: The Secrets of Being Productive in Life and Business.
3. Wood AM. Gratitude and well-being: a review and theoretical integration. Clin Psychol
investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003