Want some whine with that?

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“We’ve turned into a whining society.”
—Billy Corgan

I was feeling a powerful hankering for some random muttering; just complaining and whining for no good reason. Perhaps that is because I’m looking forward to an on-call weekend. I’m allowed to.

Life can certainly be random, and being a neuroimaging physician means that I get to partake in randomness of my own part, and also be an active player in the random acts of others. Anyone who does not understand what I’m talking about has never read the requests I am often presented with. We had a protocol for MRs at my prior institution that was only somewhat jokingly entitled “Search and Destroy Head MR Protocol”—for that very reason. You know, the request states “intermittent low back pain, dyspepsia and sneezing—please perform head MR.” What are you going to do—an IAC study? Nope. Search and destroy. Find disease. Depict it.

So, what I have chosen to whine, complain, and pontificate on is this: Seafood allergies. Or, whatever may pass for what your patient and their well-meaning primary care physician believe to be an allergy. Maybe that’s nothing more than an upset stomach after they eat 4 shrimp cocktails and down 5 martinis, but for the sake of the eternal medical record (EMR), it is now officially an allergy. Where do we come into this? Well, that patient comes for a head MR with and without contrast as ordered, and they can’t POSSIBLY have contrast media. Why? Why, of course, you silly radiologist. Allergy to seafood.

I am pretty much done debating with anyone over this point. But, let us scientifically analyze this situation. They were “allergic” to seafood. Okay. Last time I checked, by signing the paper, I am not authorizing an intravenous injection of seafood. We use many contrast media in my shop, and they are pretty specialized. They come in these beautiful packages (seen by no one but the nurse or techs), they are super-sterile, they have safe-injection tops, they have varying concentrations, different brand names, and different properties (if you care to read all about them), but they all lack one key item. Not one of them has a SINGLE SHRIMP. Or clam. Or lobster. They are crustacean-free. And do not get me started on iodine. I eat bread. And salt. And have a thyroid gland. I saw a patient allergy listing the other day that was over 40 items, no kidding. And, I am not disputing a single item, but when you see tomatoes, garlic, lettuce, dog hair, bread, and tennis ball fur on a list of that sort, you have to believe that perhaps, just perhaps, it is not realistic. I have seen and treated real honest-to-god contrast reactions. It took me hours to get my own pulse back to a semblance of normal. Everyone did okay, thankfully. And, I am a serious person, basically. However, I don’t think this navigation from “sick to my stomach eating too many somethings at the beach” and “oh, no, I’ll surely expire if you dare to inject me with that stuff” is a clear path.


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Want some whine with that?.  Appl Radiol. 

By C. Douglas Phillips, MD, FACR| September 30, 2013

About the Author

C. Douglas Phillips, MD, FACR

C. Douglas Phillips, MD, FACR

Dr. Phillips is a Professor of Radiology, Director of Head and Neck Imaging, at Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. He is a member of the Applied Radiology Editorial Advisory Board.

Copyright © Anderson Publishing 2016