Language part deux: The art of the hedge

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“Oh, what sad times are these when passing ruffians can ‘ni’ at will to old ladies. There is a pestilence upon this land. Nothing is sacred.Even those who arrange and design shrubberies are under considerable economic stress at this period in history.”—Eric Idle, in “Monty Python and the Holy Grail”

I’m certain you’ve heard this one: “You know what they say about radiologists’ favorite shrubbery. It’s the hedge! Ha!” Yeah, well, I’vegot your hedge right here. I read other people’s reports. I read pathology reports. I read operative notes. I read clinic visit notes. I don’t think we as radiologists have any kind of monopoly on a little uncertainty. In fact, while I believe we are skilled practitioners of the art, we doNOT stand alone. I started this rant last month, but I’m not done. Oh, no. Not yet.

I’m a little disturbed by the tendency of many of us to point out that absolutely NOTHING can be properly excluded by a study, regardless of the findings. Technically, perhaps it is true to point out that you can’t say “It ain’t cancer,” even with a normal study, but isn’t that

kind of beside the point? They asked you to do the study, you did it, and you’ve interpreted it as best you can. Can you miss stuff, even important stuff? Sure. And, you can misinterpret what you see. But I think the exam and our own skills are cheapened by listing 24 things we can’t say for sure something isn’t if the study is a reasonable example of the technique. So, perhaps we can be more artistic in designing the “shrubbery.”

Normal CT of the abdomen. Nothing. Nada. Not even some atherosclerotic calcifications in the aorta. You can make yourself feel better by dictating: “I’m not sure I see any pathology here, but this human is a magnificent specimen, with a beautiful liver, well-defined kidneys,and a spleen that would make most of us sing out loud. Certainly, nothing bad or potentially deleterious would hide out in there, but I might be blinded by the lovely form of the pancreas and could not be held responsible for my temporary oversight.” Ha!

Normal head MR. Nothing. Not even a white matter dot you could wax poetic about. How about this—“I am stricken by the beautiful symmetry of the white matter bundles, and the elegant infolding of the human cortex. What a developmental triumph! While no blemish is apparent on this unspeakably beautiful marvel of the human brain, evil can find a way to insinuate itself into even the most pristine of environments, and I would be remiss in not pointing that out.”

I think we can have a little fun with it, and not be viewed as silly twits. Okay, maybe not. Mahalo.

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Language part deux: The art of the hedge.  Appl Radiol. 

By C. Douglas Phillips, MD, FACR| September 04, 2013

About the Author

C. Douglas Phillips, MD, FACR

C. Douglas Phillips, MD, FACR

Dr. Phillips is a Professor of Radiology, Director of Head and Neck Imaging, at Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. He is a member of the Applied Radiology Editorial Advisory Board.

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