Tools of our Trade

I’ve had occasion to vicariously dabble in archaeology, courtesy of various media. Even been on a couple of digging sites (as a tourist, not one of the folks doing the actual painstaking work).

Perhaps as a result, I sometimes find myself musing on how far future generations (or otherworldly visitors, after we’re gone for one reason or another) might try figuring what we were all about, and how we conducted our affairs. For instance, by puzzling over the tools we used.

There’s plenty of room for error with such pursuits. Some things just won’t stand the test of time, especially as we increasingly move away from tangible to intangible. A set of radiology films and some textbooks would have yielded more clues than, say, a CD of someone’s MRI and an installed copy of the Primer of Diagnostic Imaging on a hard drive. Even less liable to be discovered by future investigators would be someone’s scan on a cloud-based PACS.

So it’s probably moot, but the notion has occurred to me that, if anyone unfamiliar with our field were to get a gander at the dictation macros we use, they might feel confident deducing what we were all about. These macros are, increasingly, the tools of our trade, and might reasonably be considered indicative of the focus of our work. Just as an archaeologist might figure that ancient people who had an abundance of saws and hammers did a lot of woodwork.

The problem with this is that I’ve noticed an awful lot of our macros aren’t focused on what I suspect most of us would like diagnostic radiology to be known and/or remembered for.

Glancing down the master-list of my macros, for instance, one would see a healthy number, if not a preponderance, of items having nothing whatsoever to do with the description of findings from imaging studies, or even recommendations based on them (such as guidelines of the Fleischner Society).

Instead, these macros are focused on ancillary matters I dictated frequently enough that I got sick of repeating myself, and found it efficient to macro-ize:

• My standard line for when I have seen no abnormality in the anatomic region which was imaged, but the provided history didn’t give any localizing details (for instance, X-rays covering an entire extremity for “pain”).

 • Informing or reminding the reader that there are other studies performed at the same time as the one I’m dictating, but they will be reported separately.

• Technical limitations for studies (patient motion or habitus, metallic hardware, etc.)

• Specifying that previous imaging studies and/or reports of the same are either unknown to exist, or unavailable for comparison.

• Documenting verbal communications (or attempts at the same) with various clinical and ancillary staff.

• Reminding the reader, in the Impression of a report, that other findings were also mentioned in the report’s body.

• Protocol-related issues (contrast would have added to a study, MRI would have been more suited to the “reason for exam,” no Doppler images provided, etc.)

• Verbiage for addenda (to my own reports, or those of currently-unavailable rads) to clarify dictation-errors or other items of interest to clinicians and ancillary staff.

• Quantification of dosages (contrast, radiopharmaceuticals), or fluoroscopy time.

• Advising that, even though no prior studies were provided for comparison, if any exist they should ultimately be compared.

• Enumeration of images in a study presented for interpretation.

• Usage of multiplanar reconstructions, MIPs, 3D recons, CAD…

• Procedural-housekeeping stuff (“Informed consent was obtained,” etc.)

There are more, but I’m not at my workstation to view them at the moment (can you blame me? I spend enough time there).

Still, hopefully the flavor has been conveyed: Looking over how much of our verbiage we use frequently enough to warrant the crafting of a macro, one might easily get the impression that we spend an awful lot of our time doing clerical, housekeeping, bean-counting, and generally non-physician-like stuff.

Good thing that’s not really the case, right?