Fawlty Radiology

November 7, 2014

When no one reads the words on a radiology report, a frequent occurrence.

Fans of John Cleese, or indeed Monty Python, may be familiar with the brief lived britcom “Fawlty Towers.” The titular character, Basil Fawlty, proprietor of a resort town hotel, struggles his way through each episode trying to keep the place functioning, if not always smoothly. He’s generally unafraid to assign blame, best summed up by Cleese himself: "[Fawlty] could run a first-rate hotel if he didn't have all the guests getting in the way.”

Years of frustration, perhaps, are to blame for his tendency to impatience and sarcasm with such obstacles. For instance, a guest insists he draw a map of how to get to the post office. Map now in hand, the guest asks where on the map the PO is to be found. Fawlty seamlessly retorts, “Right here, where it says ‘Post Office.’ I’m sorry if it’s confusing.”

Notwithstanding his hen-pecking wife’s dismissal of his “sledgehammer wit,” Fawlty comes across as a sympathetic character to most viewers. I suspect more than a few of the latter sense a kindred spirit; they have painful firsthand experience of knowing they could soar with eagles if they didn’t routinely work with turkeys. Someone giving the turkeys some grief in return, even if only in a fiction, can seem downright heroic.

I routinely find myself in situations which could easily mirror the post-office-map exchange referenced above. Just last week, for instance, some doc in some ER phoned up wanting clarification on a CT I had read: Had I seen the appendix? I looked at the two-paragraph report I had rendered, which had hedged not at all and addressed all pertinent negatives (indeed, there had been no positives), and if I had indulged my inner Fawlty I might well have said, “Yes, if you’ll notice where I dictated ‘Normal appendix.’ Sorry if that was misleading.”[[{"type":"media","view_mode":"media_crop","fid":"29242","attributes":{"alt":"Car on flooded street","class":"media-image media-image-right","id":"media_crop_2047147445942","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3033","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 167px; width: 250px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Then, during the same week (same night, I think), I got a request for an addendum on another pretty much normal CT. Site wanted a comment regarding the aorta. Could I really have signed a report without something so basic in it? Nope…there it was, in simple black and white, as normal as everything else. So, what aorta-related comment could I addend without being redundant? Temptation was strong to dictate a Henry Gray quote: “The aorta is the main trunk of a series of vessels which convey the oxygenated blood to the tissues of the body for their nutrition.”

But, of course, we hold back from such behavior (at least, if we have a shred of restraint). And few, if any, of us directly confront our clinical colleagues (or the noctors replacing them) for failing to read our reports before picking up a phone to ask us to spoon-feed them the details. Maybe oblique references to this are a little more common: “Oh! I’m sorry, did my signed report not come through on your system?”

After all, those of us fortunate enough to have lived vicariously through Fawlty already know what sort of payoff (more like payback) he generally received for his antics…and we’re not eager to emulate him quite that thoroughly.