The Extra Mile Has No Finish Line

Recently I had the honor of speaking alongside faculty from the Royal College of Radiologists at the joint RCR-CRS-AOSR symposium REAL session. REAL stands for Radiology Events And Learning. Dr Rachel Magennis spoke candidly about the trauma and sacrifices radiologists face (including her own) in the unforgiving world of medicine. Dr Sri Vaidyanathan presented difficult diagnostic cases that resembled a clinical game of Where’s Wally? Dr Ram Chittal closed the session with “Learning from Excellence,” showcasing good catches made by radiologists who had gone the extra mile. These doctors could have stopped after answering what had been asked. Instead, they kept looking.

Dr Ram celebrates all the sharp eyes and good catches from his colleagues.

The phrase "going the extra mile" traces its roots to a Roman practice under which soldiers could compel a civilian to carry their gear for one mile, or specifically one thousand double-paces (a mille passus). It was an everyday reminder of who held power and who was expected to submit. Those pressed into service would carry the burden until their obligation was fulfilled, then presumably set it down begrudgingly and walked away, not a step more.

This became the backdrop of a biblical teaching. Jesus told his followers: “If anyone forces you to go one mile, go with them two.” Among the many explanations, it was a radical strategy for regaining agency, power, and human dignity in the face of coercion. By choosing to continue, the carrier transformed imposed service into voluntary action. Over time, this “second mile” became our “extra mile", the effort given after obligation has ended.

Like athletes, most extra miles had a discernible endpoint. Professional athletes may spend years without knowing whether their sacrifices will pay off, but they know when their performance counts. The whistle blows, the clock starts and the finish line is visible. Similarly, when the restaurant crew presents a surprise birthday cake, the guest’s reaction provides instant, unfiltered feedback.

Don't let HaiDiLao know it's your birthday.

Healthcare often works in reverse. Going the extra mile may result in nothing happening at all. The incorrect medication never reaches the patient. The faint abnormality is not overlooked. Subtle deterioration never becomes a crisis. No news is genuinely good news. Any serendipitous sightings are seen as professional duty, and the exhaustive effort goes unnoticed.

Organizations, meanwhile, experience a much easier time turning individual zeal into standard operating procedure. Going the extra mile begins as desirable, hardens into a norm and eventually becomes an invisible clause in the job description. The second mile is quietly folded into the first, usually without any corresponding increase in time, staffing or support. Once discretionary effort is demanded, it becomes another compulsory mile, a familiar reminder of who holds authority and who is expected to carry the burden.

Admittedly, the boundary between professional duty and going the extra mile is not always clear. Radiologists are expected to remain vigilant, and detecting the unexpected is part of their expertise. This is not an argument for excusing negligent or haphazard practice. It is about the difference between a proficient professional reaching a reasonable and defensible judgement (the first mile) and continuing to search for something after satisfying the original request (the extra mile).

Human factors science helps explain why that continuation is cognitively demanding. Human attention is selective, not panoramic. Inattentional blindness describes how something visible, like a dancing gorilla, may not enter conscious awareness when attention is directed elsewhere.

In this experimental study, radiologists reportedly did not notice the gorilla embedded within this CT chest image.

Incidental findings are also often rare and subtle. A miss can occur not simply because one "did not see", but at any of three stages: scanning, recognizing, or decision-making. Repeated exposure to normal cases compounds the difficulty through the low-prevalence effect, shifting expectations towards absence and making rare abnormalities less likely to be detected.

Ultimately, this satisficing self-terminating search task means every radiologist must eventually decide that enough of the image has been examined. Workload and time pressure may bring that endpoint forward. The extra mile therefore asks radiologists to continue searching for an undefined target (which may not even be there) after they have already reached a fair and justifiable conclusion.

A culture of going the extra mile thus cannot be built by requiring everyone to travel it. As Dr Ram’s examples revealed, many good catches occurred because someone trusted a lingering doubt, remained tenacious, and felt safe enough to seek a second opinion among fellow professionals. Leaders should not conscript dedication, but recognize it, celebrate it and learn from the conditions that allowed it to emerge. The aim is not to extract another mile from healthcare professionals, but to make the first mile sustainable and the second visible.