This Is The Information Age in Radiology?

March 27, 2013
Douglas G. Burnette Jr., MD, CFP®

The digital age is supposed to mean that information is available quickly and widely. Instead, I am getting less information than ever.

If this is the information age, why do I have so much trouble as a radiologist getting information? The digital age is supposed to mean that information is available quickly and widely. Instead, I am getting less information than ever.

Early in my career I read an article that reached the conclusion that when the radiologist was told where the patient hurt, the accuracy of the report was increased by 65 percent. My reaction: Duh!

Don’t get me wrong, I enjoy reading how many six packs had been ingested prior to the improbable catastrophe and all the other non-relevant social commentary more suited to Facebook as the next guy. It just doesn’t help me understand what I’m looking for.

Social histories notwithstanding, the electronic age has not helped the quality of clinical information one iota. Assurances from administration that reasons for each examination were required fields notwithstanding, it was obvious that anything typed into that field would suffice. We immediately began receiving the cryptic “DO” as the reason for the exam. At first I thought it was a simple command but later learned it actually was an abbreviation for “Doctor’s Order.” Much more informative.

At one hospital the “Reason for Exam” field is limited to 55 letters. Heck, you get more than that with Twitter. Standing orders are apparently no longer allowed so they are sort of understood rather than written, leaving the hapless ward clerks to stretch their imaginations, if not their vocabularies. This results in unimaginative clinical indications for daily ICU chest X-rays such as, “daily while in ICU” or “am portable.” Not much help there.

There seems to be a competition to reduce the clinical information provided to us to the minimum number of words. “Pain,” “SOB,” “AMS,” “dizziness,” “weakness,” “Preop,” and “MVC” predominate.

I have noticed that requests from certain physicians have only one indication such as “cough” for every chest X-ray they order. Either that is the default entry on their computer screen or they are piping in some toxic tussive gas into their waiting room.

I am equally convinced that the various patient rooms in the emergency department are named for symptoms. There is the chest pain room (aka cp), the trauma/injury room, and the SHORTNESSOFBREATH room. The order entry system must be pre-populated with the name of these rooms. How else can you explain a foot X-ray on a patient with the clinical indication of “chest pain?”

Naturally, we try to get the information we need to interpret the study in any way we can. The technologists are supposed to provide us the real reason for the study based on their interaction with the patient in the technologist comment section. This is usually very helpful and frequently critical to the proper interpretation of the study. Not infrequently, however, the official reason for the study and the technologist’s comments are contradictory. The stated reason for the exam is “chest pain” and the technologist states “patient denies any chest pain.” What am I supposed to do with that? More importantly, why would a government bureaucrat ever allow payment for this study as medically necessary?  

I have struggled with this issue my entire 30-plus year career because I sincerely want to help the patient and his or her doctor. My goal on every imaging study is to answer the question that the requesting physician wanted answered when they ordered the study. To do this I need to know what that question is and unfortunately, that doesn’t appear to be important to anyone else. The national symbol of radiology isn’t the hedge, it’s the mushroom.