The Radiology Whisperer

May 22, 2015

Someone should be interpreting what the radiologist is saying.

As is I’m sure the case with physicians everywhere, I’m more than occasionally approached with medical questions by friends and family. Happily, sometimes radiology is the subject of interest (as opposed to the finer points of which statin is better, or whether I have any insights regarding a rash my questioner eagerly brandishes for me).

Even within the radiological sphere, I often feel the need to begin and end with disclaimers about what I have to offer. For instance, when someone tells me, third-hand, what was said about a chest CT (neither images nor report available to me) and asks what I think, I feel I cannot underscore enough for them how much pertinent detail is missing from the scenario for me to say anything useful at all.

Given more to go on than that, there’s still often the matter of explaining the scope of my subspecialty and routine practice: I’m doing nobody any favors by pretending I can capably review their ankle MRI, and while I might have something to contribute by looking over their mammograms, they should know that the last time I routinely read these things was years ago, whereas the rad formally reporting the mammo has his/her skills honed on a daily basis.

All that said, there is still frequently something I can contribute to the situation, even without images or reports. This is often because the patient in question (whether my questioner, or someone known to him/her) has had things less than clearly, completely explained. Or, subsequent to the moment of explanation, the patient has had time to mentally digest the information and come up with new mental question marks…and tracking down their health care providers with follow-up queries is at the least a chore, and sometimes seemingly impossible.

There’s also an ever-increasing volume of information, and patient access to it. A two-page abdominopelvic CT report, chock-full of incidentalomas, may well not be thoroughly discussed between a primary care doc and his patient. First, the doc has limited time with each patient; second, the doc might not want to overload the patient with details of little consequence; and third, the doc himself might not fully understand the details beyond the radiologist’s assurance that these things are of no import (and reported only out of a sense of completeness and/or avoiding overzealous peer review action).[[{"type":"media","view_mode":"media_crop","fid":"37968","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5693399864340","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3770","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: 129px; width: 200px; float: right;","title":"©igor kisselev/","typeof":"foaf:Image"}}]]

Nevertheless, the patient, report now in hand and discovering he has a handful of pulmonary nodules, hepatic and renal ditzels, aberrant vessels, and nonaggressive bone lesions, is to be understood if he gets a little concerned that not one of these things has ever been mentioned to him. After all, our bloated bureaucracy of a health care system has proven to bear more than an occasional resemblance to a sieve, and horror stories abound of important things that slipped through the cracks. Someone with a clue or three about medical imaging, a radiology whisperer as it were, can act as a sort of interpreter for the typical layman patient, and relieve much anxiety.

Patients also stand to benefit from radiology- whispering before undergoing imaging. Knowing that contrast might improve the diagnostic yield for a study, for instance, rather than mutely proceeding to get a noncon scan which was less-than-appropriately ordered. Being aware that breath holding and remaining still on the scanning table will result in better images, even if the technologist’s instruction to do so goes unheard or is inadvertently not given. Bringing along something to mark the area of interest prior to image acquisition, lest the order simply state “pain” and the interpreting radiologist have no idea.

Ideally, radiology whisperers performing these functions would be completely redundant, as physicians and ancillary staff would be doing all of them already. Such might be the case if we (the rest of health care, as well as radiology) were not in an endless cycle of churning out productivity at ever increasing paces to stay afloat. I don’t see the trend changing anytime soon…maybe, instead, there’s entrepreneurial hay to be made in offering office hours for radiology whispering services.