How Rigorous is Your Self-Editing of Radiology Reports?

I was recently asked to be a guest for a podcast (The Radiology Report), which went live this week (https://t.co/dYrGqpNbgn ). The invitation originally came around the holidays. During this time, we tried making a “Christmas pudding” with shades of Merrie Olde England. It was something of a production and for those unfamiliar, that ultimately included lighting the thing on fire. We captured that on video as well as my lady’s reaction to actually tasting the thing since she was convinced it would be comedically negative. (As it happened, she was pleasantly surprised until she had a minor allergic reaction.)

Watching the video before to posting it for friends and family to see, I was reminded that I really don’t like my recorded voice. I felt the need to comment that I sounded much better from inside my own head and began to wonder whether I might ultimately hate myself for agreeing to the podcast.

I went through with it and felt the recording treated me kindly. I have happily been able to sit through the entire playback without cringing. I definitely found myself wishing I had said one or two things differently, added something else, etc. However, that brings me to the topic of this week’s blog: Under the right circumstances, I have a nearly limitless capacity for editing my own work.

Those “right circumstances” include having sufficient time and perceived importance of whatever I am editing. This blog is a good example. Once upon a time, when I was working a seven days on, seven days off telerad job, I had a solid week in which to write upcoming blogs. I would typically get a chunk of the pieces done in the first day or two, and then revisit them for multiple sessions of tweaking. Sometimes it amazed me how much I kept on finding to change.

Elsewhere, if I found myself with only a day or two to get everything done, I found a way to accomplish the same thing. Sometimes, things felt a little less polished but there have been more than a couple of blogs that I have felt great about after a single session at the keyboard. It has occurred to me that my propensity for editing is akin to a goldfish’s ability to grow to the size of its environment. (By the way, that isn’t quite as straightforward as it might seem. I looked that up to check the veracity.)

Knowing just how much time I can spend improving a piece, I have tried making a habit of never sending an email or other written communication without at least double-checking it, and preferably setting it aside to review later. Otherwise, it is amazing to see what can slip through the cracks. I try not to let that keep me up at nights given the substantial volumes of radiology reporting I have to sign.

(Editor’s note: For related content, see “What They Didn’t Tell You About Voice Recognition Software” and “Why Being a Situational ‘Completionist’ is Perfect for Modern Radiology.”)

Thinking about it, though, one of these blogs comes out to a page or two on my word processor. Compare just a few hours in a week spent on the blog versus churning out 100-plus radiology reports in a workday (and a lot more cases than that in some previous jobs). A few minutes spent with my eyes more on the images than my voice recognition screen just can’t compare. What kind of drivel am I electronically signing my name to?

Like a goldfish confined to a small bowl, though, I really don’t have a viable choice. Once upon a time, when rads read a fraction of what they do now, it was another story. We’d sit down after the transcriptionists had gotten through a chunk of our caseload and review our reports before signing them. There were two sets of human eyes to screen out nonsense or poor word choices.

That addresses the time factor, but I also mentioned “perceived importance” of my editing subject matter. In these blogs, or in other writing like a letter to my accountant in tax season, I really want every statement to land the right way. Otherwise, there are consequences or, at the very least, embarrassment when I see that something I said sounded dumb or was frankly wrong.

What’s important in a radiology dictation? There is a lot of unimportant verbiage we have to include, which dilutes (sometimes drowns) the key stuff. This may be technical factors nobody cares about, hedges and disclaimers as well as government- or department-mandated boilerplate info. We can take care of a lot of that with automatic templates, but not all of it. If something incorrect or ungainly finds its way into this word salad, is anybody going to care?

Once upon a time, I cared a lot more about sounding good. If my reports contained grammatical errors, for instance, colleagues, referrers, or patients might think less of me.

I haven’t stamped out that motivation entirely, but it’s been beaten down quite a bit. How could it not? Most of the cases I receive have nothing resembling a scholarly (or even coherent) clinical history. I routinely get calls for clarifications or addenda indicating that whoever is reading my reports isn’t exactly an appreciative audience for the finer nuances of language. Heck, I consider myself fortunate when it turns out that they have a basic understanding of the medical issues at hand. “Pearls before swine” is too harsh an expression, but at the moment I can’t think of anything more charitable.

It also doesn’t help that, even when I was still making greater editorial efforts for my rad reports, I found that the voice recognition software was constantly working against me. The machinery tirelessly inserts the wrong words/phrases, messes around with pluralization, and otherwise does things its programmers evidently thought would be helpful.

“Tireless,” however, did not describe me as I gradually gave up trying to retrain the machine and manually fix all of its stupid blunders. At some point, I started letting some of its nonsense go when it’s clear that none of the important interpretive findings were being obscured. I have other things on which to expend my energy, emotional and otherwise.