It never ceases to amaze me how a holiday-shortened workweek can seem paradoxically longer than a normal five-day affair. Nibble away a Monday—say, for Memorial or Labor Day, or better yet Thursday and Friday (thanks, still-sorta-new job, for being my first gig that let me experience Thanksgiving the way normal people do!), and somehow, the remaining days just seem to drag on that much longer.
So there I was, going through a typical bundle of cases with eyes towards my upcoming break, and a brain scan bore the all-too-familiar “R/O TIA” as the reason for exam. Far from the first time, I fantasized a world in which I could just dictate “Imaging cannot rule out a transient ischemic attack. Thank you for this fascinating consult.” Next case.
(Of course, if the study had actually shown a stroke, it would have ruled out a TIA in the same way one might rule out a benign tumor by diagnosing a rip-roaring malignancy. But let’s not quibble; the study was normal, and the only way to know if there had been transient neurological signs/symptoms would have been, to coin a phrase, correlating clinically.)
Such imaginary retorts would probably be with me regardless, but I’ve got to imagine I’m more predisposed since my childhood was enriched by Mad Magazine’s recurring feature, “Snappy Answers to Stupid Questions.” For readers unfamiliar, I, first, offer my condolences for being shortchanged on your youth, and, then, suggest a quick Googling of the phrase for some catching up.
Times have changed, and some of the humor might be dated, but I suspect folks will always have a deep-seated itch that gets satisfyingly scratched by the notion of giving blunt, maybe-sarcastic answers to questions that had no business being asked. This is especially true when actually giving such answers would be maladaptive, if not catastrophic, to one’s relationships, social standing, and career.
Ask a bunch of radiologists about the dumbest “reason for exam” questions they’ve encountered, and many of them will probably be similar…heck, I’ve mentioned them more than a few times in this column over the years. One of the side-effects of reading an ever-increasing number of studies per day is that your sample-size grows to the point that trends are much easier to identify.
This diverges from another phenomenon about which I once wrote: Cases with entirely legitimate histories that 99-plus percent of the time turn out to have virtually identical readings. For instance, in my residency we noticed that just about all CXRs for “chest pain” in relatively young patients would be stone-cold normal. With such cases, you might know, with nary a glance at the images, what the interpretation will be. But, the clinical histories themselves are reasonable and don’t lend themselves to “snappy” retorts.
There are a handful of others in the same boat as the “R/O TIA” mentioned above, where the provided history is more or less irrelevant to the exam. “R/O pain,” for instance, practically begs for a radiological impression of “Cannot rule out pain—suggest you ask the patient how he’s feeling.” Same for “R/O pathology,” really, since even a head-to-toe scan isn’t going to exclude cyclothymia or a viral upper-respiratory infection.