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Avoiding the Misfortunes of Those Being Imaged


Clinical histories can help radiologists improve differential diagnoses. They also can help me avoid the misfortunes of those being imaged.

It is no secret that most radiologists wish they received more thorough clinical histories than they currently do. 

With even a little bit of information specific to a given patient, we can substantially fine-tune our differential diagnoses and even our search patterns. Even in the absence of such tangible gains, the courtesy of a written line or two which required a moment’s thought from a referring clinician can result in a sense of being a valued member of the interacting health care team.

I also like clinical histories for their potential to help me avoid the misfortunes of those being imaged. For instance, every single person I have ever encountered as a result of snowmobiling has been in mid-workup for trauma - not getting on one of those contraptions anytime soon. A few years ago, I would have said the same of ATVs, but the Mexican sun evidently addled my risk/reward appraisal one day in Cabo, and I now have an n=1 of safe ATVing.

Physical altercations also seem to be a no-no. I’m sure it’s possible that every injured soul in the ER has a corresponding unscathed counterpart who did not need medical attention, but even a 50-50 chance of being the one with contusions, concussion, fractures, etc. is too great for me to go picking fights.

By far, however, the most important risk factor I have encountered has been minding one’s own business. Do this, and you’re inviting the world to throw its absolute worst at you. Ask any of your clinical pals in the ER about it: When a patient’s story beings with “I was minding my own business,” the history is guaranteed to get nasty. Minding your own business leads to assaults, car accidents, getting struck by falling or propelled objects (including projectiles from firearms and crossbows), buildings collapsing under or around you, food poisoning, falling (sometimes considerable distances), drowning, choking - you name it. I wouldn’t be surprised - if alien abductions have actually occurred - that the abductees were minding their own business when taken.

I believe a huge amount of medical misfortune could be averted if only we got the word out about the dangers of minding one’s own business. Fortunately, I believe society is ready for the news. Not all that long ago, privacy and unobtrusiveness were considered good and desirable things, and there may have been resistance to this idea. Now, however, we can’t get enough of other people’s affairs. Just look at the rip-roaring success of reality TV.

As healthcare professionals, we should be taking a leadership role in this issue, nothing less than a crusade against insularism and its comrade-in-arms, privacy. I suggest we begin by taking a meat-cleaver to the beast known as HIPAA.

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