Magic Words that May Boost or Tank Your Radiology Cred

One of the first rules taught to radiology residents in our interventional suites was “When you feel resistance, don’t push harder.” It made good sense and anybody with a bit of imagination could imagine the sorts of catastrophe that might result from ignoring it.

During my second or third IR rotation, I had occasion to obey the rule. Wire was not advancing easily so I stopped where I was until the attending could take a look. He just happened to be the guy who most frequently cited the “don’t push harder” rule. Checking the wire, he curtly congratulated me for following the rule and said that I was now ready for the advanced level reasoning: “Sometimes, it’s okay to push harder.” He subsequently did that and the procedure went on without incident.

A lot of things are like that. We start out with simple rules that are easy to remember, follow, and understand. Later, we learn other rules that contradict them because we have gained the sophistication to know which rules should apply to a given situation.

Here is another case in point. “Don’t judge a book by its cover” is good, general advice for the younger crowd. It remains valid for the long haul but with experience, you eventually learn subtleties and exceptions. Young doctors, for instance, sooner or later learn “When you hear hoofbeats, think of horses, not zebras.” A book’s cover might just have some relevance, and you would be foolish to completely ignore it.

That can yield some interesting and even entertaining surprises. For example, I have known a couple of pretty brilliant radiologists who sported accents that aren’t stereotypically so brilliant. You might hear them speak and seriously underestimate their intellectual prowess but then be wowed after seeing them in action.

A lot of our interactions in radiology don’t allow for such prolonged exposure. Folks forming a snap impression of us, however erroneously, might not stick around long enough to find out they were wrong. I don’t want some referrer to doubt me just because of the way I said something.

There are more than a few ways to come across as credible. I recall one of my first hospitals offered accent reduction classes for folks like those I mentioned above but that struck me as time and effort intensive. A much easier way focuses on the actual words one says rather than how one says them.

Put another way, if you say (or dictate) things in a way that capable radiologists would, it will more likely be assumed that you are one of them. If your verbiage is that of a charlatan or uncertain newbie, that is probably how you will be perceived.

Consider a quirky example I noticed early on in my career. Talk to the vast majority of people about imaging, and they will refer to one modality as MRI. There is absolutely nothing wrong with that, but a small subset of sophisticated folks (mostly rads) will call it MR. Your mileage may vary but, in my world, the folks using that second abbreviation always seem to be most on top of their game.

At the very least, referring to the modality without saying the “I” is like presenting a business card that says “I know about diagnostic imaging.” People might not even take conscious note of the credential you just displayed, but it will connect you in their long-term memory with a handful of other imaging-savvy individuals they have encountered who also dropped the “I.”

Consider an opposite example. One of the less brilliant rads I knew early in my career was full of malapropisms, unintended ones that practically screamed out “take everything I say with a grain of salt.” He referred to shotty lymph nodes, for instance, as “shabby.” I wish I could say that prolonged exposure to the guy eventually taught me that he knew what he was doing but unless you count shady business practices, he did not.

Speaking in ways that only a sophisticated radiologist would can cause its own problems. Take, for instance, referring to the “middle lobe” of a lung in your reports without using the word “right.” One hopes that anybody who has been through medical school or, indeed, a decent anatomy class, would know that the left lung normally doesn’t have a middle lobe. Nobody says “left lingula.”

Still, most health-care folks—including docs—typically refer to the RML, not the ML. If you don’t (whether out of intellectual honesty or machination), you’ are rolling the dice that referrers — especially noctors who didn’t pay so much attention in school — will ring you up asking for clarification. Maybe you will enjoy educating them, but I think most of us would rather not have the interruption.

It can be fun to assemble a repertoire of “things brilliant rads say, including me,” to trot out like parlor tricks. I didn’t showcase my list of them here because, unfortunately, I couldn’t think of too many. Hopefully that means that they are genuine bits of my vocab rather than bits of artifice.

If I were to advise a rad who is looking to harness this sort of maneuver (especially a young’un who is just starting out), I wouldn’t suggest particular words and phrases so much as an overall tone. When you are speaking to be taken seriously as a rad, try channeling people in your past whose knowledge you respected.

Evoke, for instance, your best teachers, professors and mentors. Hopefully you can recall some wise, well-spoken elder relatives. Avoid colloquialisms or terms you might not fully understand (and thus use wrongly).

There is nothing technically wrong with a report saying things like “the lymph nodes look normal to me,” but it doesn’t sound masterly. I find it more useful to sound stodgy than casual. I can save the down-to-earth talk for when I am away from the workstation.