Summary:
Dr. Phillips
is a Professor in the Departments of Radiology, Neurosurgery, and
Otolaryngology-Head and Neck Surgery, and the Director of the
Division of Neuroradiology in the Department of Radiology,
University of Virginia Health Systems, Charlottesville, VA. He is
also a member of the edit
Dr. Phillips
is a Professor in the Departments of Radiology, Neurosurgery, and
Otolaryngology-Head and Neck Surgery, and the Director of the
Division of Neuroradiology in the Department of Radiology,
University of Virginia Health Systems, Charlottesville, VA. He is
also a member of the editorial board of this journal.
One part of my job that is actually nice is the chance to call
something normal. Well, okay, with all the reimbursement rules,
insurer oversight, and other nonsense that we have to deal with, it
is rare to just end a report with the word "normal," but sometimes
that is just what it is. Normal. The end. However, have you noticed
how some referring docs just can't take no for an answer?
Normal?
Can't be
normal
. Impossible. There are certainly clinical practice areas in which
this happens more often than in others. I'll leave that to your
imagination. Let me give you the scenario I live through a few
times a day. In this instance, the referring clinician will be
referred to as
RC
. I'll be the smart ass radiologist (SR).
RC:
Hey, what did you think about Mrs. Kleebotenschadel's head CT?
SR:
It was normal.
RC:
Hey, thanks! See you later.
RC heads for door, but hesitates, does his best Columbo
last-minute turn (you younger folks can ask someone a bit more
advanced in years about that…), and ducks back into the reading
room, just adjacent to your elbow.
RC:
So, there wasn't any hemorrhage?
SR:
Nope. Have a nice day.
RC:
Hey, thanks! See you later.
Ditto prior turn.
RC:
So, you didn't see any mass?
SR:
Nope.
RC:
No fracture?
SR:
Nope.
This can go on for hours. "No mass effect?" "No sinus disease?"
They can go around in tight circles more times than a NASCAR
driver. Makes me dizzy sometimes to watch. If there is an end of
this discussion, it has largely in my practice (an academic
practice, with lots and lots of residents) been this:
RC:
Is that a final read?
SR:
Uh, yes, that would be the final read.
We've all thought about what we'd LIKE to do, but haven't ever
done it. All right, make that
I've
thought about what
I'd
like to do:
RC:
Hey, what did you think about Mrs. Kleebotenschadel's head CT?
SR:
It was normal.
RC:
Hey, thanks! See you later.
Ditto prior turn.
RC:
So, there wasn't any hemorrhage?
SR:
Ooooohhhh!!! Got me! Yep, there was. Big, big hemorrhage. Forgot
all about it! Thought I'd get you with that one, but you're just
too quick.
One of my prior mentors thought a normal report should be a
single word:
Normal.
That meant that you'd looked at everything and had nothing but
normal
to report. While there is incredible simplicity and even a large
dose of common sense in that approach, life is much more complex.
At least, that's what I'm told. I've kept copies of those reports.
They are almost of historical significance these days. Can you
imagine an insurer seeing a report on a PET/CT that read "Normal"??
Well, this colleague wouldn't deal well with this new (improved)
approach, I would imagine. In my mind, I've seen things being
thrown at anyone who suggests an embellishment to the word
normal
. Way normal? Unbelievably normal?
Radiology. Can't live with it, can't live without it.