Wet Read: Simon Says?

By C. Douglas Phillips, MD, FACR
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Dr. Phillips is a staff Neuroradiologist, Department of Radiology, Weill-Cornell Medical College/New York-Presbyterian Hospital, New York, NY. He is also a member of the editorial board of this journal.

What is it that you like a lot? Chocolate? The beach? Ferraris? I’ve got a lot of things that keep me happy in life, as I guess most of us do. After you have figured out the staying alive part, you want things that make you smile. How about when you’re on the job? I’ve found one thing that keeps me smiling on an intermittent basis – radiology requests... Whoa, what people will put on requests.

A few of my favorites. Clinical data. We need it, we crave it, we gotta have it. It’s the law, for God’ssake.

How about these?

“Jello wrestling, sprained neck.” There’s a whole category here, the “tad bit too much information” line.

“Resisted arrest, and has multiple abrasions about face and neck following repeated contact with cement.” Hmmm, how on earth didthose happen? Must have tripped a lot.

“Fell 50 ft.Back pain.” Must have landed on his head.

“Hit by car. Needs radiology.” Yep, at the minimum. And a lawyer.

“Sees monkeys. MR.” Head MR for the patient or the monkeys? Orbits or head?

How about the combo request and plea?

“Please perform cervical MR and provide interpretation.” How about just the interpretation? Leave the patient out of this; we have a sale on wild flights of the imagination.

“Lumbar spine MR and pay close attention to the L5 root.” Yeah, I often disregard that one.

Or the single-word requests. No data, just a presumed diagnosis and a question mark.

“HNP?”, “Stenosis?”, “Stroke?” wouldn’t you love to send the report back as a single word? “Nope”, “Yep”… Ha! Or how about “Huh?”,“ Where?” or “What makes you think that?”

I worked with an incredible neurosurgeon who sent requests in the form of his latest letter to a referring clinician as the clinical info. It was a chance to get the opinion of a very insightful clinician examining the patient.

“I don’t think there is a thing wrong with this nice man, and his exam is normal, but because he insists on complaining of back pain, I’ll get an MRI and EMG of his lumbar area.”

“Thank you for referring this very interesting patient. I think she is entirely functional, and in better shape than myself, but she really wants a myelogram, and we will get one. I don’t think I can help her with her back pain, unfortunately.”

On the flip side, how about the helpful although minimalist ICD-9 clinical data?

“ICD-9, 796 - Abnormal Clinical Findings.” Wow, that opens the door, eh? Too bad I don’t get reimbursed more for my own diagnosis when doing these, “ ICD-9,799.2 – Nervousness.”

I have, to this point, intentionally avoided the handwriting on the faxed ones. What do these people use for pens? Bloody fingerstumps? Are they inspired by Jackson Pollock? I have seen 4 heavily educated people standing around a piece of paper trying to guess the words, and make them medical, not scatological. How can you protocol an exam on this info?

Greasy hyponatremia odor?

Fatulic chronic hypismagogal?

Stay happy, my friends. This is a great field, and somehow, despite the diversions, we still manage to provide great medical care.

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Wet Read: Simon Says?.  Appl Radiol. 

August 12, 2010

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