While prose-style radiology reports are still considered most accurate and complete, and still most commonly used by radiologists,1 template-based reports have been attracting considerable attention as of late.2,3
I can’t help but wonder why.
My own opinion is that not only do template-based reports thwart more creative thought, but their growing popularity is also leading to increasingly verbose, repetitive and cluttered reports that can trigger chuckles of amusement, at best; and unleash fear of lawsuits and other serious consequences, at worst.
Indeed, I’ve come across some reports so blatantly superfluous that they are actually funny: “Normal abdomen radiographically with no visualized acute diagnostic abnormalities evident within the abdomen on this examination at the present time radiographically. Opinion: Abdomen within the range of normal.”
I’ve seen other reports that breach basic logic through needless repetition: “Pneumonia is bilateral, seen in both lungs”
Obviously redundant and illogical elements like these impair the quality and accuracy of our reports and may, indeed, increase the risks of adversely affecting patient care.
I think that one can trace the cause of this problem, at least in part, to the world we live in, which is filled with efforts to make ideas appear better than they actually are; look no further than marketing and advertising messages, which often consist of not much more than long-winded, somewhat dishonest and manipulative rhetoric. I think also that many radiologists believe the longer their reports, the better and more impressive they—and their reports—will look to others. While long reports can and probably do impress some medical students and naive doctors, in my experience, they make a poor impression on most readers.
Robert Allen, MD, the eminent pediatric cardiac surgeon at Le Bonheur Children’s Hospital, once said to me, “Please don’t put all that needless stuff in your post-op radiology reports. Mention only significant findings.” Similarly, David Carroll, MD, the University of Tennessee Professor of Radiology and past president of the American College of Radiology, always insisted on brief reports.
(Let me emphasize that I don’t have anything against long radiology reports per se; complex studies and interventional studies certainly, and often, require longer reports. My concerns focus mainly on reports documenting less complicated, normal studies, or follow-up studies without change.)
Drs. Allen and Carroll were right to insist on brevity. No less an authority than William Strunk, Jr., co-author with E.B. White of The Elements of Writing, wrote in the introduction to that classic primer, “Vigorous writing is concise. A sentence should contain no unnecessary words, a paragraph no unnecessary sentences, for the same reason a drawing should have no unnecessary lines and a machine no unnecessary parts.”
Strunk and White were on target, and many of us radiologists would do well to apply Occam’s Razor (also known as the Principle of Parsimony), which says the shortest and least complicated way is the truest, to the writing of our reports. If Sir William of Occam were practicing medicine today, I’m sure he would take many patients off all medications and start with a clean slate; if he were playing basketball, he would shoot straight for the hoop, rather than bank off the glass.
Thus, it is in this spirit of saving paper, toner and time—yours and that of your readers—that I offer the following pearls of advice for shortening your traditional narrative reports without losing their all-important meaning to your referring physicians and their patients.
I have been told that shortening longer reports into more concise forms lessens their value. Why? Is it because the use of wordy reports has become so pervasive that doctors have become accustomed to their lengthy, needlessly embellished style and accept it as normal and proper? It would be just as logical to say the value of a report doubles if you double the number of words.
I have never seen evidence of radiologists’ not getting paid or being sued for concise reporting. Indeed, I have spoken with the billing officers at the major Memphis hospitals and have been told they do not get claims denials because of concise reports.
That said, let me just note that my libertarian leanings obligate me to assert that everyone should be free to report findings his or her own way. “Let a thousand different flowers bloom,” as the saying goes, and the best ways will gravitate to the top. I hope some of you will consider my ideas and even implement some of them.
Still, I can’t help but wonder what my colleagues would think if I started making my reports twice as long as they usually are. How would I explain myself? I can only imagine that I would plant tongue firmly in cheek, smile with a twinkle in my eye, and say, “It just looks so impressive.”
Editorial: Making a case for concise narrative radiology reports. Appl Radiol.