How To Sound Smarter (Or at Least, Avoid Sounding Dumb)

I’ve touched on the subject in previous blogs: There are an awful lot of ways we radiologists can wind up sounding stupid in our reports.

Some of it is beyond our control: We’re given lousy, or even downright wrong, patient clinical information, and foolishly believe, thus report upon, what we’ve been told. Or we’re forced to use specific verbiage (however much we hate it) by the government, our superiors, or must-be-appeased referring clinicians.

Other aspects are a little more avoidable. For instance, voice recognition software that, no matter how much we retrain it, utilize macros, and whatever other tricks we’re figured out, seems bound and determined to transcribe idiotic blunders to which we’ll sooner or later sign our names. We might find and fix 99% of these embarrassments with proofreading, but an overflowing worklist and a gazillion distractions will conspire to get a few past our metaphorical goalie.

I’m of a mind that the deck is stacked enough against me in this game…no way am I going to add to it by voluntarily dictating anything that makes me sound less than my best. I imagine most rads would express the same sentiment…but I’ve seen/heard some cringeworthy utterances, sometimes on a routine basis from an individual rad. Here’s a few, off the top of my head:

The lesion [or other anatomical structure] is small [or large] in size. What other than size would words like small/large reference in a rad report? Is the lesion likely to be small in spirit? Petty? This goes for other tautological phrases like “round in shape.” Reminds me of the dopey airport announcements that a boarding call is the “last and final.” Really? I guess that means we can safely ignore anything if it’s merely “last” or “final.”

Seen…identified…noted…visualized…Granted, unless you’re in the habit of using sentence fragments in your reports, it can be difficult to avoid using these entirely. But whenever I mention in my report that I see something, part of my mind retorts: Really? You see [whatever]? Go figure, a radiologist saw something. Which other of your five senses are you using when you interpret these images? Go on, lick the monitor and tell me what you think of the liver now.

A male uterus? A female prostate? It’s a nuisance to glance over at the patient demographics for confirmation in the middle of reporting a case, but it’s a bigger embarrassment to report wrong gender viscera. Plus, a hassle when someone requests you render an addendum. Shout out to vRad here, for having software that gives you an alert if you try to sign off a report with wrong gender innards (it also safeguards against right vs left, metatarsals versus metacarpals, etc.).

For further evaluation…followed by other imaging modalities such as MRI. Good thing you specified that the imaging was for “evaluation.” Otherwise, the clinician might think you were proffering therapeutic benefit. Or that you were offering ideas as to interesting things the patient might do with his day.

Pneumonitis of the lungs…scoliosis of the spine…arthritis of the joints... The day you identify a case of splenic pneumonitis, or scoliosis of the kidney, you should probably write up a case report on it.

As described…please see above…discussed in body of report, etc. This one can sneak up on you. If you let it into your dictation repertoire for Impressions, it might start out as something you only use when there is a LOT of detail you want the reader to note…but the threshold for using it has a funny way of creeping lower and lower. Next thing you know, almost all of your reports are saying something like it…even when the Body of the report and the Impression are each only one or two sentences long. Guess what: If a clinician isn’t in the habit of reading anything but the Impression, you saying “See above” isn’t going to change his ways. And it won’t save you from the ambulance chasers, either.