To Counterfeit-Coin a Phrase…

June 22, 2020

When imaging studies evoke classic movie sentiments.

I’ve been known, when I find a movie to my liking, to re-watch it…more than a couple of times. Probably ad nauseum, to most. The habit is mine, and I own it. But, I do point an accusing finger at cable TV providers who have made a lot of hay out of showcasing the same couple-dozen flicks, over and over, each month, while they’ve got thousands of options to choose from in their stockpiles.

Unsurprising, then, that I am able to recall more than a few scenes and their dialogue—in detail that some might find disturbing—at the slightest provocation. I’ve learned to curb my “Y’know what this reminds me of?” reflexes in my social interactions, lest that become way too much of a stock-phrase for me. It does not do much, however, to silence my internal dialogue.

Sitting at my home-office workstation, having only imaging studies for company, my mind conjures up things I imagine might be said to anyone involved. And, that is usually the referrers, since the “clinical histories” they’ve theoretically provided are sort of like questions or statements, with my expected response being a dictated report. My internal encyclopedia of movie-spawned quips has been known to offer some alternatives.

For instance, one of my many cases this past week was an abdominopelvic CT with a particularly unhelpful clinical history. It might not even have had one (that sometimes happens when there is literally nothing written on the case documentation. I have no idea how such studies manage to happen. Fortunately, they are rare).

As is not uncommonly the case with such exams, nothing particularly abnormal showed up on the images, and I spent more time puzzling over clues as to what could possibly have prompted the imaging than potential diagnoses of significance. As I reluctantly moved to sign my uninteresting report, this came to mind:

“[Referrer X] has dishonored himself and dishonored [our healthcare system]. I have tried to help [Referrer X]. I have failed. I have failed because [Referrer X] has not given [me a proper clinical history]!” (Apologies to Sergeant Hartman and Full Metal Jacket.)

Again, the majority of these imagined quips tend to be directed at the referrer. And, as long-term readers of this column will know, I have had more than an occasional bone to pick with their inability (or disinterest) to provide appropriate clinical information:

“Throw me a frickin’ bone here!” (Dr. Evil, Austin Powers franchise)

“What we’ve got here is failure to communicate.” (Cool Hand Luke)

“You can't rely on anyone these days. You gotta do everything yourself. Don’t we?” (Joker, The Dark Knight). When, having gotten zero clinical info from anyone else, I’ve gone digging in previous imaging-study reports, and come up with some relevant, even vital piece of clinical history.

Then, there are the times I’ve had to speak with a referrer (or one’s underling) about something stupid and timewasting. Like, my report says the study is normal and includes the usual list of pertinent negatives. Now, they want to ask if I looked at the appendix. Of course, while I’m on the line with them I’m entirely courteous and professional. But, it takes everything I have to keep from saying “Bye, Felisha” (Friday) out loud at the end of the call.

Sometimes, fellow radiologists (or other docs who fancy they can comprehend a scan) come to conclusions about an imaging-study different from my own and want me to support them:

“Yeah, well, you know, that’s just like, your opinion, man.” (The Big Lebowski)

But, it’s not always about casting aspersions on other healthcare personnel. Sometimes, it’s a reaction to the imaging studies themselves. Such as, when I’ve started looking over a study, and begin to see some awful, unexpected pathology that’s going to ruin the referrer’s day (not to mention the patient’s):

“I’ve got a bad feeling about this.” (Multiple characters in the Star Wars franchise.)

When I’ve made a tricky diagnosis, especially if others previously have not:

Damn, I’m good!” (Ace Ventura: When Nature Calls) Hey, I never said the movies I endlessly re-watched were all priceless classics.

Or, when I’ve opened a new case, and it’s a complete disaster: Patient thrashing around, weirdly positioned to begin with, contrast in wrong phase or absent, developmental-variant anatomy, deformities from surgery, pathology all over the place. Good heavens, where am I going to begin on this one? Why did I even open it?

“Well, here’s another nice mess you’ve gotten me into.” (Oliver Hardy, multiple instances)

And, then there were the days when I’d get called up about whether a 600-lb patient could undergo cross-sectional imaging at our facility:

“You’re gonna need a bigger [scanner].” (Jaws)

Or when my worklist is empty:

“Feed me!” (Audrey II, Little Shop of Horrors). Happily, not as much of an issue since I left vRad, where an empty worklist meant I was earning absolutely no money for my time.

Rarely, the would-be speaker of the quote isn’t me. For instance, when the PACS, RIS, or some other aspect of my workstation-rig stubbornly won’t do something it should, I can practically hear it telling me:

“I’m sorry, Dave. I’m afraid I can’t do that.” (Hal-9000, 2001: A Space Odyssey)