Your Friend, The Editor (Part 1)

June 29, 2020

Contemplating an editor for radiology reports.

I’ve been writing this column, believe it or not, since 2011. It seems safe to say I have some skills when it comes to putting words together. However good or bad at various facets of it I may be, I feel comfortable in calling myself a writer.

I have also, from time-to-time, taken on a related role: that of an editor, for instance with my med school’s student newspaper. I don’t think anyone would be surprised at the notion that there is considerable overlap between the skill sets of writers and editors.

Even if one assumes no difference in aptitudes between the two, their focuses and goals differ. As a writer, I might want to put forward page after page in the name of sharing my every thought with whichever readers might be interested. As an editor, I might trim someone’s submission to be more digestible.

In last week’s column, for instance, I referenced (humorously, I hope) a number of movie-quotes with relevance to my practice of radiology. One that might have been the funniest was from a Samuel L. Jackson character in Pulp Fiction: I substituted the oft-misused “R/O” in healthcare for the word “what,” in one of his mini-tirades (his first scene, in which he and Travolta are interrupting some young folks’ breakfast).

I make these specifications lest readers want to imagine what would have been in the column…because it wasn’t. That particular quote was edited out of the piece. I guess because the quote had some salty language in it, and even though I liberally replaced letters in the naughty words with asterisks, I’m guessing that was considered insufficient.

Some writers might be disappointed, even outraged, when they see the work they have done being so altered. They can lose sight of the (I cringe to use the trite term) “value added” by an editor other than themselves. Not just in terms of massaging a piece to better appeal to a desired target-audience: There are things that only a different set of eyes (and associated brain) will notice when reviewing a piece.

Self-editing is unavoidably subjective; you need somebody else if you want an objective appraisal. I typically review an entry of my column multiple times before emailing it to my editor for publication. I almost always trim or adjust something on each pass. No matter how many times I go through this, however, if I subsequently see it online, I might still wish I’d said something differently. And, then there are any number of things that might seem fine to me, even with a dozen re-readings, that my editor might recognize at a glance as needing tweaking for better consumption by others.

I’ve had more than a few thoughts along these lines when contemplating the numerous pages’ worth of radiology reports I create in a typical working-day. Far greater volume is generated there, under (partially self-imposed) pressure for better speed and productivity…yet how carefully am I proofreading those reports? Maybe one speedy going-over before hitting “Sign?”

Granted, in that context I’m not trying to be witty or thought-provoking. As long as I’m accurately conveying what an imaging study showed and what it means, my mission is accomplished. Grammar, even spelling, don’t have to be perfect. Indeed, in the name of efficiency and giving the voice-recognition software less to mess with, I have embraced the usage of sentence fragments, as much as it initially offended my sensibilities to do so.

I have nevertheless come to wish that we had some sort of editor other than ourselves, in the radiological workflow. As it stands, the only editing we get tends to be when someone has an issue with reports we already signed, and, then, the best we can do is to make an addendum…which leaves the original content untouched (and highlights it as an imperfection to subsequent readers).

Some places I’ve worked have innovated a layer of software for this purpose. If you’re trying to sign off a report on a right-sided extremity, for instance, and you dictated the word “left,” you get interrupted with a warning. Or, if you’re reading a male patient, and your report mentions the uterus or ovaries. Even if you mention metacarpals in a study of the foot, or metatarsals in the hand.

One problem with such things is that there are always exceptions, and they irritate us would-be productive workers every time they trip us up. For instance, a study was of the right hip, but the left one was also in the field-of-view, and unless I try to fool the software by saying “contralateral” instead of “left,” I’m going to get interrupted when I try to sign off.

Or, it is a female patient, and I dutifully reported on the gynecological viscera. But, the tech erroneously entered the study as being on a male patient, so the software interrupts to alert me to the discrepancy. I also once got hassled by such software when I was reading a scan on a transgender patient.

Even spellcheckers can hinder, as well as help. They can miss a great many medical terms from their dictionaries, and we radiology-drones don’t always have access to an “Add” button to tell the checker that terms like “sphenopalatine” should, henceforth, not prompt a pop-up window. Not to mention the abundance of proper names we might need to include, say when documenting that we spoke to the referrer, Dr. X, or suggesting that a patient might have Lady Windermere syndrome. Also, some dictation software auto-populates certain fields with things the techs or referrers wrote, and anytime they make spelling errors or use unsanctioned abbreviations, we’re the ones who get interrupted by software alerts at signing time.

So, I have come to fantasize about what it might be like to have an honest-to-goodness human editor going over my radiology reports before I officially sign them. And, thinking about it more than once in a blue moon, I’ve moderately fleshed out the idea. I’ll go into how such a thing might practically work next time.