Your friend, the editor (part 2)

July 6, 2020

Envisioning the radiology editor – what could that look like?

In my last column, I offered some of my thoughts about the value of an editor—someone other than a writer (whether it be of a column like this, or something else like a radiology report) to serve as an objective set of eyes in the name of fine-tuning.

As I’d mentioned, I can only imagine something so many times in the abstract before I start trying to apply details. The more I can fit in, the more it seems like my pie-in-the-sky ideas might have some legs. I’m not sure I’ve got something actionable here, but even if I never wind up taking it the rest of the way to reality, perhaps some of my notions will inspire a reader.

So, who do we want this editor to be? There might be any number of characteristics on one’s wish list for the position…but let me start with my “do NOT wants” instead:

We don’t want the editor to be a radiologist, or, indeed, any physician who might use the role (or appear to use it) as a peer reviewer. We have mechanisms for QA as it is. A lot of rads would be less than enthused at the notion of yet another person riding herd on them. The idea here is to support, not control, the rads whose reports stand to be edited. Also from a medicolegal standpoint, we’re not looking to introduce a potential witness to conflict with the rad.

Another reason not to have a doc (at least, a practicing one) as the editor -- their hands are full already. And, even if they weren’t, a physician’s time and efforts tend to come at a premium. This editor is potentially going to be producing some cost savings, but not actually generating revenue. Our editor needs to be inexpensive, which also rules out a lot of other experienced and credentialed types that might otherwise be wonderful editors.

We, nevertheless, want our editor to be someone who is attentive, industrious, able, and eager to learn (ideally about healthcare, if not radiology), and, of course, capable at actual editing skills: attentive reading and able to identify and fix errors of spelling and grammar, etc. He or she must also be motivated by something other than dollar signs.

If I wanted a strong pool of candidates for this, I’d be looking for young folks aspiring to be doctors. Pre-med students, even high schoolers planning on being pre-med in the near future. To seriously compete in such regard, they’d already have developed a goodly amount of reading/writing knowhow. Getting experience in the medical field would be a major boost for them (and, thus, they’d probably do it for fewer bucks than they would want from some other job).

Broadening the search a bit, we might consider med students (on clinical-rotation or on an extracurricular basis). Even certain types of residents might find it useful to spend a week or three as a radiology editor. Heck, a radiology resident on a less-than-hectic rotation might be drafted to do some editing. Perhaps some rad techs or department clerks could contribute (when they had nothing else to do, on an extra-hours basis, or even if not actually employed in the practice at the moment).

So, whoever it turned out to be, you’ve got an editor. Maybe even more than one. How does he or she fit into things?

Obviously, one or even a couple of editors aren’t going to be able to take care of all the radiology reports a practice generates—even if the group isn’t covering 24/7/365 facilities. Plus, the more “STAT” a report is, the less room there is for an editor to be inserted into the process.

Depending on how much the editorial workforce can take on, some proportion of the remainder might be chosen: Every 10th report, say, that isn’t urgently due could be put into the editor’s worklist. Maybe some rads don’t like the idea of being edited and are allowed to “opt out” so their reports are never in the mix. Maybe certain referrers are known for being picky, so a greater proportion of the studies they ordered get edited.

Once a rad dictates a to-be-edited exam, the thing goes into a Preliminary Status, where it can be seen by the referrer (or, indeed, anybody with appropriate access to the system). While still a Prelim, the report can be adjusted by the rad as much as he or she likes—since it wasn’t formally signed, he or she has a free hand, rather than being limited to Addenda.

When the editor has gone through the thing, it gets flagged for the rad to review one last time, to make (or ignore) whatever adjustments the editor suggested, and, then, formally sign it as a Final report. If a study is nearing the end of its TAT (turnaround-time) and the editor didn’t get to it, it gets flagged for the rad to sign, with an advisory to the rad that no editing occurred. Perhaps the edited reports even get a tag-line for the practice to show off what it’s doing. (“This report was processed with our premium ExpertEdit workflow!”)

Especially as the editors get more comfortable and experienced with this role, they’ll be able to take on more than just fixing spelling or grammar. Maybe, reading a report, they note that the rad referred to a lesion on the left kidney here, but the right one there. Perhaps, having gained some familiarity with rad-speak, they can see that the report might be confusing to read—for instance, referring to liver lesions in an early paragraph and, then, going back to say something else about them a page later. Or, maybe, the editor sees key findings in the body of the report that didn’t get mentioned in the Impression. Maybe a rad made some snarky remark about a referrer or other staffer involved with a case, or even the patient—the editor might gently suggest that this could cause needless trouble.

A radiology editor might also be of use when a referrer wants something clarified in a report. At least half the time I get requests for addenda or other after-signing clarifications, whatever the caller wants has, in fact, already been addressed in my report. If the report says the patient is post-appendectomy and a nurse wants to know why I didn’t mention the appendix, don’t interrupt me while I’m working on other cases or otherwise doing doctorly things: Let the editor help her with her reading comprehension.

Alternatively, if a caller’s concern does merit some additional action, the editor can take it on by directly fixing verbiage if the report is still in Preliminary status or taking down the details to then convey to the rad for him or her to addend an already-signed/Final report.