Editorial: Rethinking the language of obscurity
Dr. Phillips is a Professor in the Departments of Radiology, Neurosurgery, and Otolaryngology; the Head and Neck Surgery Director, Division of Neuroradiology; and Vice Chair of Finance in the Department of Radiology, University of Virginia Health Systems, Charlottesville, VA. He is also a member of the editorial board of this journal.
Our section has been reading a considerable volume of MR studies these days. A bit of clinical history that was provided on a recent request (yes, we do occasionally get clinical history) spurred a discussion that has led to this little discourse. The request provided the clinical history of "NSTEMI and unresponsive." Hmmm, NSTEMI, government code for something, I'm sure. I think they are in the office down the hall from the IRS. After puzzling over this for a while, a page to the medicine resident gave us the answer--"non-ST elevation myocardial infarction." The request could have just said "heart attack," but where is the mystery in that? Our subsequent discussion centered on the language of our specialties, the relative obscurity of many terms, and, unfortunately, the lack of useful data often transmitted to the people who have requested the examination.
How many times have you included not only in the body of a report, but also in the IMPRESSION, the statement "T2 hyperintensity"? How about "T1 shortening"? There are thousands of these phrases-technical descriptors and physics statements that are well known to radiologists. So, what do those phrases mean to the patient who reads the report, or to the physician who requested it? Very often, they mean nothing and they often earn us a phone call to figure out what we meant. What we have often done is to cloak our real meanings in terminology that we reserve for discussions among ourselves. There is considerable utility and meaning to these phrases when used among radiologists and technologists and with our trainees, but they should not be canned. Additionally, in the body of a report and in the description of findings, they often are very meaningful. There is a time and place for everything, however.
It has been said that obscure language is one of the protective elements of subspecialization. We use this language to isolate ourselves, keep others unsure about what we do, and protect our jobs. I don't always buy that, but I can see the point. As radiologists, we are particularly sensitive about the phrase "in the dark" anyway. I've previously spoken my mind about protecting our turf and jobs. What I have a problem with is the use of the language when other, more straightforward, simplistic, and, often, more meaningful language can be used.
The American College of Radiology has championed proper radiology reporting, and has offered a standard for it. The impression of a radiology report should be the "plain language" (my words) overall meaning of the findings on the study. Why, then, would we want to conclude a report with the final impression "area of restricted diffusion in the middle cerebral artery distribution"? Couldn't we just conclude "acute infarction"? I see many reports from private hospitals and private practice settings, and this problem is not unique to academic institutions. It is everywhere and we should stop it.
I propose that we all take a deep breath and work on making our final word on imaging studies a phrase that the average physician, patient, man-on-the-street, etc., could find meaningful in the context of the clinical information provided. Sometimes the report may conclude that "this finding is of uncertain significance or etiology," but that is often a fair and honest statement and points to our lack of an answer based on what we are seeing. I think most of us would agree it is far better to say a sentence of the simple truth than a paragraph of technical parameters and obscure information.