Enjoying Quiet Moments Amid the Boilerplate Blather in Radiology Reporting


Acknowledging the repetitive reality that accompanies productivity incentives and seemingly extraneous verbiage to satisfy certain insurance requirements in radiology, this author has developed an appreciation for filler-free brevity and quiet.

I have chosen to work in jobs with productivity incentives since 2011. Accordingly, as a diagnostic radiologist, I have every reason to constantly be speaking. If there is anything to be dictated and I am not talking, that is potentially wasted time.

The moment a case hits my screen, I want to verbally hit the ground running. Whether it is describing technical factors, limitations and ancillary history that didn't auto-populate., there is plenty for me to say even before I have identified any abnormalities (or pertinent negatives) on the images.

Every now and then, though, I experience some moments of silence. This may be due to figuring out the most relevant prior studies, reading their reports, rearranging the PACS display because it never quite got all of my preferred layouts, etc. I have come to like it when I have an excuse to shut up.

Part of it, I suppose, is that an awful lot of what I dictate is repetitive. Go figure. Reading a hundred ICU chest X-rays in a day, I wind up saying the same sort of things a few times (albeit not quite identical enough to result in a reusable macro). It gets a little boring.

However, even if I am saying the same stuff over and over, and little of it is intellectually satisfying, there is always some stress. Whatever I say, there is a chance that the voice recognition (or some other aspect of my hardware/software rig) will bungle it and try to transcribe something that makes me look foolish. I need to stay attentive to my humdrum utterances and be ready to correct whatever my faulty tools do with them.

(Editor’s note: For related content, see “Reining in the Boilerplate Info on Radiology Reports” and “The Top Five Blogs of 2022 from Eric Postal, M.D.”)

There is also repetitiveness to findings on more advanced imaging. It might be useful and/or interesting to a referrer to know that a liver lesion is a hemangioma but to a rad, the finding grabs from the same bag of dictation phrases used in thousands of similar lesions in cases gone by. Our minds might have the simple flash of satisfying recognition: "Hemangioma. Now on to the rest of the case." However, our mouths still have to go through the more tedious descriptive details, all spoken many times before.

Having to pause now and then is therefore a pleasant break. It reminds me of my pre-productivity-incentivized days (which, not so coincidentally, were also pre-voice rec), when the routine was to put up a scan, look over the whole thing while jotting down notes and measurements, and then dictate it all out. "TTD," one of my residency's attendings used to declare as he reached for the microphone. (Then, if anybody new was in the room, he would smirkingly explain "time to dictate." He never failed to find that amusing.)

At some point, I started talking a little less away from my workstation. I have to babble all day for my job, so it is that much nicer to do less of it elsewhere. Switching from on-site work to telerad back in 2011 also cut back on my verbal interactions with ancillary staff. Yes, I sometimes talk to my dogs while working from my home office, but I wouldn't give that up for anything.

There have been non-work-related factors cutting back on my verbiage too. I have grown to place greater value on listening than speaking for more than a few reasons. First, I already know anything I have got to say, but I am liable to learn more if I clam up and let others do the yapping. Second, one can score more points with people if one lets them have the spotlight (and looks interested in their input). Third, the more I say, the greater the chance that some of it will be wrong, make myself look bad, or otherwise work against my own interests.

A lot of the verbiage in a typical radiology report is, to my way of thinking, wasted. There is essentially boilerplate info we have to include to appease this regulatory entity or that insurance company. These are small paragraphs of technical factors that nobody reads. Then, heaven help me, there are various turns of phrase that I was effectively trained to adopt in order to make myself a slippery target for ambulance chasers and quality assurance (QA) snipers over the years.

All of that stuff, combined with other "filler" that one is pretty much obligated to include in conversation if one wants to get along in polite society, has made me uncomfortably aware of just how little of what we say really matters.

There is no way to measure it, but just imagine if you could get a computed proportion of your valuable words divided by the total volume of your speech. It would be akin to a verbal IQ but in this case, a lower number would make you a smarter talker. Many TV show hosts and most politicians would score particularly poorly. Maybe some of them would even be proud of that, but I would just as soon not rank alongside them.

Indeed, hearing some folks with a propensity to blather often reminds me of one of the innumerable gems from The Hitchhiker's Guide to the Galaxy by Douglas Adams. An alien, living on Earth for far longer than he had intended, muses on the habit of humans to constantly speak without conveying any useful information. He develops a theory: "If they don't keep on exercising their lips, their brains start working."

Such aliens or like-minded humans may or may not be among us. If they are, I wouldn't mind appearing a smidge smarter to them by shutting up when I can.

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Nina Kottler, MD, MS
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