You Have Some "Splainin" to Do

Eric Postal, MD

How much detail needed for a report depends on the situation.

Not long ago, on a docs’ forum I frequent, a hospital-based radiologist told of how he’d been informed that he’d soon have a visitor to his reading-room. It was to be one of those “physician extender” types, probably an NP. The individual was going to shadow him for a few hours as part of a training-requirement.

The forum-posting, and reactions of other docs on it, touched a few aspects of the situation: Just how much was the rad (in a non-academic post) supposed to be teaching this brief visitor? And how much could said visitor really learn in that small space of time? Was the rad supposed to get just as much work done as usual? And do we really want to be part of a process that even pretends to enable non-physicians to do what we know took nine-plus years of medschool and postgrad training for us to handle?

Reading the exchange, I was reminded of one of the attendings in the department where I did my fellowship. He wasn’t one of the shining academic stars, but did bring stuff to the table, especially pragmatics. More than a couple of times, I heard him discouraging housestaff from, in his view, overly explaining things in their reports. “It’s not your job,” he might have said, “to tell the clinician why you know this lesion is a hemangioma. Just say what it is and move on.”

A counterargument might be that, if you don’t explain how you came to your conclusions, someone else looking at the study might take issue with them. Next thing you know, you’re getting phone calls to discuss cases, requests for addenda to explain yourself after the fact, or even medicolegal accusations that you might have otherwise avoided.

Counter-counterarguments could then include that anything excessive you say in your report, shades of Louisville oral-board exams, might come back to haunt you. Or that, while you’re busily churning out explanations as to why this is a benign lesion and that isn’t a fracture, referring clinicians are getting frustrated with the encyclopedic reports you always seem to generate. Not to mention that you’re sandbagging your own productivity by taking, say, 10 percent longer with each dictation and proofreading (you are proofing your reports, aren’t you?) than you otherwise would have.

Rads vary widely in terms of how frequently they engage in intra-report explaining. I’d imagine vanishingly few can say they absolutely never do it, since it seems impossible to avoid in some situations. It’s surely impacted by the rad’s level of experience (in general, and pertaining to what populates his or her case-mix), personality, and reporting-style learned from mentors.

I’ve also found my explaining-rate swiftly adapts to who’s sending me cases. If referrer A makes a habit of calling to talk about every little thing or requesting addenda on every patient, I tend to proactively pepper A’s reports with a lot more reassuring verbiage. Referrer B might be more inclined to take my declaration of “no significant pathology” at face value and not need so much wordiness, so B’s reports are routinely going to be more slimmed-down and to the point.