Laundering Language: Interlopers Who Want to Put Words in Your Radiological Mouth

A radiologist recently posted with dismay on social media that he had clicked on his “mild” pick list for coronary macros and got a fat paragraph of verbiage added to his CT report. The verbiage was stuff he had never said or written. Some administrative type had taken the liberty of messing with his macros.

Social media being what it is, a lot of the comments got lost in the weeds with folks talking about coronary arteries, whether calcification in coronary arteries is significant, what a rad’s role should be in addressing them, etc. A few did manage to stay on point of who the heck, if anyone, should be allowed to tell a practicing physician what to say in the medical record.

Unfortunately, this particular horse has long since left the barn. It has crossed multiple state lines, started a new life for itself, and sired additional generations of horse that won’t ever go near that barn in their lifetimes, much less reenter it so the doors can be securely closed again.

I have written blogs on the subject a few times over the years, dating back to 2011. It wasn’t a new phenomenon then nor had I just learned of it. Most docs are introduced to the subject before they even finish med school. You will say and write many things not because they are what you think, but because other people effectively force you to do so.

This justifiably outrages many when they first experience it. To be a physician, one spends an average of four years working hard in med school, and that is only if one managed to gain entry after years of other hard work in undergrad. Then there are additional tough years of residency.

You sacrifice much of your young adult life, go into debt, and live under constant threat of ruinous med mal action for the privilege of a demanding profession. Now some yahoo with maybe a bachelor’s degree is going to put words in your mouth? By the way, these words will cause you, not him or her, trouble if they ever prove to be problematic.

It is like a criminal laundering ill-gotten loot. If the non-physician telling you what to put in your radiology report tried to put his or her verbiage in directly, it would be a flagrant violation. This person has no business mucking about in the medical record. But this non-physician takes his or her little opinions and strong-arms a bunch of physicians who depend on him or her for clean credentials (or the insurance entity for third-party payment): Parrot and legitimize my non-doctorly statements or else.

Actually, it is rarely one individual. Most often, there are several folks, maybe organized into an important sounding committee or agency. Sometimes there is even an individual with a credible degree involved to add a sense of legitimacy.

Back when I was newer to this game, my issue wasn’t even about non-physicians doing this. It rankled me even when other docs indirectly stuck their noses in my work. BI-RADS had been mandated just before my time and the attendings who trained me were still adjusting to its use. One could argue in favor of the system’s value or find faults with it, but none of that changed the fact that people not in the reading-room were telling you how youmust practice medicine.

Since then, plenty of others have hopped on the language laundering bandwagon that allows them to practice medicine without licensure or accountability. Politicians and their minions, third-party payors (who are usually more focused on rejecting bills than they are about shaping care), and even risk management types have all gotten in on the act. Why wouldn’t they once the trail has been blazed for them?

It should thus come as no surprise when administrative types at hospitals or even outpatient imaging centers take the liberty of reaching into your macros. After all, they are just making sure you are compliant with the policies of the house. Indeed, a couple of comments on the social media posting indicated that the coronary verbiage was for MIPS. (I will spare you the explanation of MIPS. Look it up if you like.)

With everybody and their kid brother piling on to add their “say what I tell you” directives, it is a wonder our reports aren’t even longer and more burdensome to read than they already are. If any clinicians find the verbosity helpful, they have got to be a tiny minority. I would imagine the extra clutter more frequently adds wasted time and even confusion than doing any good.

If one were to conduct a survey of clinicians on the matter, I bet most would prefer that reports on their patients contain as little of this excess fluff as possible. In this day of ChatGPT and the like, it might be nice to offer the option of putting all the third-party mandated verbiage at the very bottom of the report so docs (and even patients) could clearly see what the rad had said minus outside interference.

Maybe there could be a “hide” button for readers to keep the garbage from offending their eyes. Alternatively, I would be tempted to put a line above that section: “My official dictated report ends here. Below please find statements which have been required by my employer and licensing/credentialing authorities, over which I have no control.”

That could get me labeled as a troublemaker, but it might just be satisfying enough to merit the risk.