I turned to the medical student and put the needle down. “There,” I said, “do you see the Scotty dog?” The medical student looked at the fluoroscopic screen and then at me, dumbfounded. It’s one of my favorite interactions with medical students. Some don’t even know what a Scotty dog is, much less where or how to see one in the anatomy of the lumbar spine. The students always give it a try, mumbling something like, “I think… so…” or “Umm… yeah, isn’t it right…over…”
It’s an unfair question to be honest. One of those pimping questions attending physicians ask students or residents and never expect them to get right. But the exercise of the student thinking and trying to work it out or just keeping their nerve in an almost impossible situation
le situation is good for their growth. At least I think it is.
So what is a Scotty dog and why does this matter? A Scotty dog is a Scottish terrier, and it matters because it is the anatomical landmark used in visualizing the approach to perform a transforaminal epidural steroid injection, usually done to relieve pain in patients with a
Case courtesy of Dr MT Niknejad, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/20547?lang=us">rID: 20547</a>
herniated disc and sciatic pain down their leg. The transverse process, superior articulating process, and inferior articulating process all look like the snout, ear, and front leg of a Scotty dog when looked at from a certain oblique angle. You have to kind of know where to look to see it.
It’s important because it represents training and knowing what to look for. In pain management training and in medical training in general, we are taught to recognize certain things, most of which are only visible when you know what to look for. The Scotty dog is a great example of this – if you don’t know what you are looking for, you’ll likely never see it. Once you have seen it, you practically never not see it again.
So much in business, and in life in general is in knowing what to look for. Some of us have this almost by instinct, some of us don’t. But we can all pick it up with experience. And the only way to gain experience is to get out there and try new things, stay open to new ideas and projects, and keep learning. There are many opportunities with new technologies, new ventures, and new fields that are waiting to be explored. If you know where to look…
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