Ever Play 20 Questions with a Referring Physician?

I have this conversation at least once a year:

“Hi, it’s Dr. Smith from the ED. Just wanted to follow up on that abdominal CT we ordered on Jane Doe.”

“Oh, yes…I signed that report awhile ago. Normal scan.”

“It’s normal? Because she had right lower quadrant pain.”

“Yeah, I saw that in the clinical history…nothing to account for the pain.”

“No appendicitis?”

“No, appendix looks totally normal.”

“No abscess? No obstruction?”

“Nope, nothing-normal study.”

“No colitis, nothing like that?”

“No. Normal study.”

“Hmm. No ovarian cyst or other badness in the adnexa?”

“No. Nothing. Normal scan.”

“Nothing, huh? No stone in the kidney or ureter?”

If you’ve ever had the dubious pleasure of participating in one of these little exercises, you’ve surely found yourself considering some of the sarcastic replies that I have fought to suppress (thus far, successfully).

For instance:

“Oho! You got me…I was trying to keep the stone a secret. Can’t fool you, can I?”

“Well, yes, there’s appendicitis since you asked, but aside from that the study’s normal.”

“No, when I said ‘normal,’ I meant it. But don’t let that stop you-there are at least six more diagnoses in the differential for this patient’s clinical history! Can you name them all?”

“I’m sorry, you’ve already used up your twenty questions for this patient; I have to move on to the other ten STAT full-body scans you ordered.”