Revisiting Applications of Radiologist Cant

Every now and then, glancing through the throwaway publications that come my way, I find something of genuine interest. This month, it was “E-Prime,” a subset of the English language that excludes forms of the verb “to be.” Explanations of why this might be desirable, and how it came about, are easily found online. They include better writing, speech, and even thinking.

As treatments of E-Prime will tell you, it is not easy to modify your basic linguistics. You clamber over each and every sentence, trying to replace all of the “to be” variants without mangling your intended meaning or sounding awkward and clunky. I am sure it eventually becomes more natural, like gaining proficiency with a new language, if you remain committed to it.

That said, we all do similar things with our usage of language. One constantly updates the way one speaks as one learns things and adapts to the ever-changing world. However much you may loathe (or love) “politically correct” speech, you have probably adopted some of it over the years if only to avoid the negative consequences of not doing so. Similarly, if some element of PC speech doesn’t popularly “take,” you might quietly drop it from your repertoire.

You might even have taken nibbles at using E-Prime without realizing it. In writing, one is often warned against excessive use of the “passive voice,” and nixing forms of “to be” (especially “was”) goes a long way in this regard.

Closer to home, a lot of radiologists avoid “to be” and its ilk. That can be a bad habit, part of a generalized tendency to hedge. Declarative statements that make for helpful radiology reports often use words like “is,” and avoiding those terms leads to wishy-washiness. Compare “The appendix is normal” with “No appreciation of appendiceal pathology,” or “There is no acute injury” with “I do not see any evidence of trauma.”

Generally, using the hedgier lingo doesn’t protect the rad from medicolegal liability. I don’t even expect it does much to avoid dings in one’s QA stats. At best, it provides an irrational sense of security, maybe adopted by young rads when they see their mentors doing it.

Nevertheless, when enough of a population adopts a certain way of speaking, it takes on a life of its own, and others notice. If you are a rad, you have probably encountered more than a few docs of other specialties who think they are being clever teases by working “clinical correction recommended” into their conversations with us.

Thinking about this stuff reminded me of a blog I wrote back in 2016 (have I mentioned how neat I think it is that cheap memory lets us archive everything we do?), the original “Radiologist cant” blog. We rads have certain ways of speaking while on the job that we don’t bring into our non-medical lives. Other rads, and many non-rad health-care personnel, understand us, but if we spoke “in character” while outside of our workplaces, it wouldn’t go as smoothly.

For instance, I have rarely, if ever, said anything was “suboptimal” outside of my radiological life. If I did, I’d probably get a weird look or two, and perhaps someone would ask me if I thought I was Mr. Spock. I definitely wouldn’t use any of the fun acronyms that festoon our workplaces, like FOOSH, BRBPR, or WHOML.

Conversely, I wouldn’t import any non-medical colloquialisms into my rad reporting. It’s not that I would get in trouble for doing so. It just feels unseemly. Not all that long ago, I saw someone’s report of a knee MR saying that a meniscus was “okay,” and just reading it gave me the creeps.

Languages evolve over time, and radiologist cant is no exception. In my original 2016 blog, I referenced voice recognition’s effect on the way we speak and the way our spoken words can be altered so that whoever reads our reports sees things we didn’t say. From context and knowing our usual verbiage, however, they might correctly divine our intended meaning.

Using such software for another eight-plus years, I have seen other ways it impacts my product. I have learned not to use certain words and phrases that I know to be troublesome. I have effectively removed them from my vocabulary, similar to how E-Prime removes is, are, was, etc. I have also greatly cut back on my usage of articles (“the,” “a,”) as part of an overall effort to use as few words as possible, since any individual thing I say is extra fodder for the machine to distort.

Referrers or other rads might find my reports less smoothly read than a bestselling novel, but they understand my cant and that of other rads who do similar. As I evolve my lingo, they evolve their ability to read it. I recall one of the attendings in my fellowship taking issue with a colleague of mine who was already dictating in sentence fragments all those years ago: “When you’re dictating under my name, you’ll be grammatically correct.” I wonder if that attending subsequently came around to our way of thinking.

It’s not all about style either. Accepted terminology shifts with the times, whether or not we are happy about having to learn the new stuff or explain it to others who still use lingo from yesteryear. If you haven’t yet had a conversation with someone about the “superficial femoral vein” versus the “femoral vein,” consider yourself lucky.

The point of a professional cant is to convey meaning more efficiently so even if there are some speedbumps along the way, the net trend is improvement. Take, for instance, Fleischner Society (FS) guidelines. They have gotten a lot more commonly known in our field than they used to be. Once upon a time, it was helpful if not necessary to cut and paste the whole FS chart at the end of a rad report so folks would know what we were talking about.

Some still do that, but more of us have moved beyond it. Fleischner has entered our cant, and we can just invoke its name while citing the specific follow-up guideline for the case at hand.