Finding the Humor Amid the Frustration with Insufficient Patient Histories in Radiology

While a lack of detail with patient histories is a common challenge in radiology, a dash of humorous perspective can help build a sense of camaraderie among colleagues.

A couple of months ago, I devoted one of my blogs to funny, stupid little things that have thrown some laughter into the cadence of my typical workday. An instance this past week had an interesting wrinkle to it: I actively chose to be entertained.

The workday was still relatively young, and I had an unusual run of cancer follow-ups for the hour. At that time, I am usually still cleaning up the “we called it STAT but it wasn’t really emergent” cases from overnight. By comparison, cancer scans can be a little mind-numbing. In the first half of a morning, my brain finds judgment of potential fractures, ruling out pneumonias, and ICU portables more palatable than re-measuring dozens of lesions and lymph nodes.

Opening up my Nth such case, I was greeted with the helpful clinical history of “ROUTINE SCAN FOR GROWTHS OF TUMORE.” It was spelled just like that in all caps. There was no mention of whether a malignancy had ever actually been diagnosed, where/what it was, whether or when treatments had last been applied, if there were current signs/symptoms, etc. It was a full-body non-contrast CT to boot and, of course, no explanation as to why contrast was not used.

I definitely could have reacted negatively. How do they expect me to do a decent job when they give me this garbage? What kind of charlatans are sending me cases? Couldn’t the tech have dug a little and given some extra tidbits of info? Is this the state of the health-care industry I can look forward to for the rest of my career (or will it get even worse)? Chances are you have heard it all, and probably had similar thoughts if they were not verbalized earlier.

Yet something about the situation whispered to my sense of humor. Maybe the part of my brain that handles snap judgments wasn’t fully awake yet, or my morning’s caffeine intake was in just the right phase of taking effect. However, it occurred to me that I had the option of choosing to find this funny rather than vexing or depressing. This was not just in a gallows humor kind of way. I prefer laughing over grumping, so it wasn’t a difficult choice at all.

I imagined the less than sophisticated clinical history being penned — or spoken — by the quack Dr. Nick of Simpsons fame or a noctor equivalent. I pictured the referring doc as being busy and hassled and asking someone else to fill out the referral form. It could be a dopey office clerk, a janitor, or a trained monkey. I imagined the patient, not yet due for a follow-up scan but wanting one anyway, stealing a form and writing the referral him or herself n their best “No, really, I’m a doctor” pseudo-jargon.

None of it had me cackling to the point that I couldn’t go on with my work. It wasn’t that funny by any means. However, the more I went on, the funnier I found it.

At some point, I shared it on one of the radiology social media platforms I frequent. Again, I could have been doom and gloom about it: “Hey, everybody, get a load of this crummy clinical history. What a mess of a profession we’ve got, eh?” I would have had at least a few takers to chime in agreement. Then there probably would have been others eager to find fault with us for complaining. You can always find rads eager to pick on their colleagues. This is especially the case in social media. Everybody is braver when speaking remotely, safe behind their keyboard. Such threads often devolve into unpleasant bickering and sniping.

However, I opted against the negative and chose comedy. That was how I presented it: “I don’t know why but getting a non-contrast pan scan just now for ‘ROUTINE SCAN FOR GROWTHS OF TUMORE’ has me unable to stop laughing.” The tone was set that this was something funny, an open invitation for others to come along and share laughs.

Yes, there was the obligatory commentary like “Please tell me a physician didn’t order that,” but most went along with the cheerier sentiment. Some added to the laughs, making me find the whole situation genuinely funnier with statements like “Impression: Two more tumores.” or “Look, cancer happens in Italy too, ok?” One summed up the situation nicely: “Better to laugh than cry.”

Interestingly enough. I had already nearly completed what was to be this week’s blog, in which I talk about Dr. Negative: a pessimistic, critical, always expressing unhappiness character you’ve surely encountered, and maybe even been yourself at some point. Hopefully, you aren’t now.

I strive to avoid that role. Identifying crossroads where positivity (humorous or otherwise) can be chosen over grimmer paths is a skill I am always trying to hone well. Having it happen out of the blue while that blog was in the works was a great “case in point” for me.

I’ll talk more about that next week.