Radiology, like all branches of medicine, is a science, but also with some element of art intermixed in it.
There is a lot of art involved in getting an appropriate image; in a sense, the art of radiology and of photography are related. This was even more true in the conventional radiology era, and still holds true for a variety of scenarios, most notably ultrasound and fluoroscopy. Luckily, this art is taught well throughout our radiology residency. Indeed, one of the fundamental things a resident ought to know by the end of his or her residency is how to obtain a good image for various important investigations, as technologists in India may not always be as proficient in doing the needful.
There is however a more subtle art deeply integrated in every medical branch, and one that is unfortunately barely taught to us during MBBS (medical school) or residency. And that is the art of communication. While the art of communication involves direct interaction with patients in most other branches of medicine, good communication skills for a radiologist usually involve writing a concise clear report which is well-understood by the the patient himself, referring physician (and potential future doctors the patient will go to), as well as other radiologists. Striking a balance between clarity for the patient, details which the referring physician needs, and lexicon which other radiologists expect to be present in the report is not easy. It is even more difficult for an otherwise proficient radiologist who is not very comfortable in English. Furthermore, it takes years of experience and deep thought to come up with personal set phrases and terms which can get easily incorporated into making a useful relevant report which answers the question.
There is a third art which many radiologists are slowly forgetting; and that is the art of being a doctor first and an ‘image-reader’ later; i.e. to be able to correlate clinically rather than asking the referring physician to do so, of actively picking the phone and calling the referring physician in case of an emergency finding rather than typing the report and expecting it to be read in due course of time, and of generally being a ‘clinician’ rather than to just refer to other doctors as clinicians (thus implying that we are not clinicians!).
This section is going to focus predominantly on the art and science of reporting. The aim is to enable budding radiologists to think as much about communicating the findings effectively as they do in catching them. We have already given some templates on reporting fractures, abdominal aortic aneurysms, and few common spine radiographs. We plan to share similar templates or phrases or dictums on how to report a particular finding, say a pulmonary nodule or an adnexal cyst. We will also discuss some do’s and don’ts on describing findings and impressions, and often use a report (anonymized of course) we have encountered in practice as an example of how to report (or not report) a particular finding. After initial more ‘macro’ blogs on the overall style of reporting, many of the subsequent blogs will be short ‘how I would do it’ examples, as for example our blog on how to write a good impression. Having said this, the art and science of reporting has to co-exist with the art and science of being a doctor first, and be prepared to encounter some philosophy en route as well!
Watch out this space for more!
– Akshay Baheti, Assistant Professor, Tata Memorial Hospital
– The blogs here will be purely personal opinions and suggestions and will have no legal validity. People’s views and opinions will naturally differ, as happens in any thing related to art. Feel free to use the comments section as a discussion forum or to voice your views.
– Everyone has his or her biases and prejudices, so to say. My own views, for example, are shaped based on my interactions with many mentors, teachers, radiology colleagues, and patients, both here in Mumbai and during my 3-year US stint. We will try to be objective and give references wherever possible, but the blogs will often be just an individual view; you will have to use it as a reference to formulate your own viewpoint.
– Apart from our own blogs, do read Dr Ravi Ramakantan’s blog in his own inimitable style on the radiology report here, if haven’t done so already. Trying to diligently implement all the 10 things he has said in your daily reporting practice will make a huge difference.