Reining in the Boilerplate Info on Radiology Reports

How do you like it when people put words in your mouth? In other words, some may claim you have said things you did not, or that you hold opinions you do not hold at all. It’s kind of infuriating, isn’t it?

In a worse scenario, others tell you what to say and could punish you if you don’t. This could range from financial penalties to blots on your professional record. Further, when you obediently parrot whatever you have been given, it is to audiences who have no way to distinguish your assigned utterances from what you actually wanted to say. As far as they know, you came up with and meant every word of it.

Anybody who has been working in radiology for even a little while knows the feeling all too well. Indeed, most of health care is probably like that by now, but I am just focusing on the corner of the profession I have lived in for the past couple of decades. During that time, I’ve seen a slowly rising, evil tide of “Put this in your report or else.” I have even written about it in this blog a couple of times.

Someone recently posted a thread about it on a radiology social media group I frequently visit. It was a semi-plea for advice about how others were dealing with the ever-increasing volume of required verbiage that was cluttering their reports. This includes stuff like contrast dosage, number of recent scans, radiation dose reduction jargon, the different types of Doppler or maximum intensity projection (MIP)/3D recons utilized, etc.

Other than an insurance company or some other regulator looking for “gotcha!” bait (as in “we found a flimsy excuse not to pay you for the work you’ve done”), who has any interest in how much contrast was used for a scan? If someone really does, the tech’s documentation can be referenced later. Does it clinically impact anybody’s negative DVT study if I don’t specifically say that color Doppler and spectral analysis were utilized?

I thought it was endearing that some respondents to the social media thread expressed a hope/belief that we could do something about this. One poster commented: “What we need to do is join up, all radiologists … and fight this absolute nonsense.”

Folks, the horse is not only out of the barn, he has crossed the country and has established a new life more inaccessible to us than if he has been in the witness relocation program. The time to assert some semblance of control over what went in our reports was back before an army of middlemen and regulators established a stranglehold on our profession. They have got the power now, and if you think you can take it back without severely disruptive change in the health-care field, you have got another thing coming.

Not all of the non-physicians who are putting words in our mouths are doing it for nefarious purposes like clawing back payments. Some are just political types looking to score points in the public eye by saying they “improved safety” in health care, etc. And there are always actual professionals in the field willing, if not eager, to get in good graces with such folks by furthering their agenda. “The (insert leading radiology organization) endorses Senator Blather’s initiative to put an extra paragraph in all CT reports stating that radiation can be bad.” Next week: “The (insert leading radiology organization) hopes that Sen. Blather will stand against these outrageous CMS cuts.”

Heck, some outsiders, who may never have tried to read through radiology reports, might not even understand that they are doing more harm than good. Why not, they might honestly think, require a statement that going above the speed limit can result in loss of life and limb? Somebody might read it and drive more carefully. What does it matter that they read the advice in a mammo report? Let’s put in an anti-smoking blurb too!

So we add an extra sentence here, and an extra paragraph there. Before you know it, we’ve got a ton of boilerplate info we have to put in our reports. It buries whatever useful information we were trying to convey and makes the whole thing less readable for referring physicians, let alone the occasional patient trying to understand his or her own imaging findings.

A couple of folks responding to that social media thread, myself included, thought it might minimize the damage if we just took all of the required verbiage and put it in a dense little paragraph at the end of our reports, maybe after a page break. In other words, let as much as possible of the required nonsense get automatically populated, or input by techs and clerks, before we even get the study to read. Have the rads waste zero time on it. I suggested that the paragraph have a header like “Required verbiage from non-physician regulators.”

For good measure, I’d say let’s make it the smallest type of font possible and do away with niceties like spaces after periods and commas. Maybe use a super-flowery font that is annoying to read. Why make it easy for the regulator enforcers? Heck, put it in an almost invisibly faint color, like light cyan on a white page.