OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Carola van Eck, MD, PhD, in response to an item about radiology reports posted on KevinMD.com by radiologist Saurabh Jha, MD.
As orthopaedic surgeons, we commonly seek consultation from our radiologist colleagues in cases where a diagnosis may not be obvious after a thorough history and physical examination, or when we’re seeking imaging confirmation of a diagnosis about which we’re quite certain. But we sometimes get frustrated when the radiology report includes phrases such as “clinical correlation recommended” or “cannot exclude malignant process,” as Dr. Jha notes in his KevinMD blog post. A related annoyance occurs when the radiology report lists a slew of differential diagnoses ranging from an ingrown toenail to cancer. Matters get even more difficult if our patients see and read a vague, ambiguous radiology report and come to our office anxious because they think they might have cancer.
But perhaps the main reason we surgeons can become annoyed by these reports is that they frequently state the obvious, and we may therefore interpret the reports as being condescending and patronizing. Informing the ordering orthopaedist that “the CT scan of the cervical spine is negative for fractures” is helpful, but reminding him or her that “CT does not exclude ligamentous injury” is not. I would like to think that such comments are not intended to be insulting, but they could very well be attempts by the radiologist to deflect professional liability. In his post, Dr. Jha reminds us bluntly that “the radiology report is a legal document.”
Regardless, if I am clinically concerned enough to order chest imaging on a post-op total hip patient who has been slow to get up for physical therapy and continues to require 2 liters of supplemental oxygen, a report that says “subsegmental pulmonary embolism cannot be entirely excluded with absolute certainty; please correlate with clinical findings” is not very helpful, because the clinical correlates are what prompted the order in the first place.
If you—like I did—thought that this frustration goes unnoticed by radiologists, it does not. Dr. Jha’s post refers several times to The Radiology Report, a book by radiologist Curtis P. Langlotz. Among many other recommendations, Dr. Langlotz (who was Dr. Jha’s attending at Stanford) admonishes his colleagues to report in a standardized fashion, to take a stand, and to use “normal” instead of “unremarkable.” Ultimately, I agree with Dr. Jha, who points out that medical decision making is all about taking a stand and that most of the time, it is better to be clear and wrong than vague and potentially not wrong.
Carola F. van Eck, MD, PhD is the chief resident physician in the Department of Orthopaedic Surgery at the University of Pittsburgh Medical Center.