Wet Read: Normal. N-O-R-M-A-L.

By C. Douglas Phillips, MD, FACR
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Dr. Phillips is a Professor in the Departments of Radiology, Neurosurgery, and Otolaryngology-Head and Neck Surgery, and the Director of the Division of Neuroradiology in the Department of Radiology, University of Virginia Health Systems, Charlottesville, VA. He is also a member of the editorial board of this journal.

One part of my job that is actually nice is the chance to call something normal. Well, okay, with all the reimbursement rules, insurer oversight, and other nonsense that we have to deal with, it is rare to just end a report with the word "normal," but sometimes that is just what it is. Normal. The end. However, have you noticed how some referring docs just can't take no for an answer? Normal? Can't be normal . Impossible. There are certainly clinical practice areas in which this happens more often than in others. I'll leave that to your imagination. Let me give you the scenario I live through a few times a day. In this instance, the referring clinician will be referred to as RC . I'll be the smart ass radiologist (SR).

RC: Hey, what did you think about Mrs. Kleebotenschadel's head CT?

SR: It was normal.

RC: Hey, thanks! See you later.

RC heads for door, but hesitates, does his best Columbo last-minute turn (you younger folks can ask someone a bit more advanced in years about that…), and ducks back into the reading room, just adjacent to your elbow.

RC: So, there wasn't any hemorrhage?

SR: Nope. Have a nice day.

RC: Hey, thanks! See you later.

Ditto prior turn.

RC: So, you didn't see any mass?

SR: Nope.

RC: No fracture?

SR: Nope.

This can go on for hours. "No mass effect?" "No sinus disease?" They can go around in tight circles more times than a NASCAR driver. Makes me dizzy sometimes to watch. If there is an end of this discussion, it has largely in my practice (an academic practice, with lots and lots of residents) been this:

RC: Is that a final read?

SR: Uh, yes, that would be the final read.

We've all thought about what we'd LIKE to do, but haven't ever done it. All right, make that I've thought about what I'd like to do:

RC: Hey, what did you think about Mrs. Kleebotenschadel's head CT?

SR: It was normal.

RC: Hey, thanks! See you later.

Ditto prior turn.

RC: So, there wasn't any hemorrhage?

SR: Ooooohhhh!!! Got me! Yep, there was. Big, big hemorrhage. Forgot all about it! Thought I'd get you with that one, but you're just too quick.

One of my prior mentors thought a normal report should be a single word: Normal. That meant that you'd looked at everything and had nothing but normal to report. While there is incredible simplicity and even a large dose of common sense in that approach, life is much more complex. At least, that's what I'm told. I've kept copies of those reports. They are almost of historical significance these days. Can you imagine an insurer seeing a report on a PET/CT that read "Normal"?? Well, this colleague wouldn't deal well with this new (improved) approach, I would imagine. In my mind, I've seen things being thrown at anyone who suggests an embellishment to the word normal . Way normal? Unbelievably normal?

Radiology. Can't live with it, can't live without it.

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Wet Read: Normal. N-O-R-M-A-L..  Appl Radiol. 

January 16, 2008
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