“The world is full of obvious things which nobody by any chance ever observes.”
—Sir Arthur Conan Doyle
in “The Hound of the Baskervilles”
Sherlock was right, again, as always. The man had a tendency to be right much more often than not. In fact, pretty much always. Don’t you wish you could ride a streak like that for a few years? But, I partially digress. What I wish to pontificate on for a few short minutes is the task of the radiologist as fact-finder. Digger. Hunter-gatherer. Detective.
I’m sure you’ve had that mysterious exam in the queue some morning. Likely went untouched by anyone for at least a few hours, getting riper by the minute and awaiting someone to open it and explore its fascinating (or completely UNBELIEVABLE) findings—a true rose about to bloom.
Or a hand grenade about to go off.
So, in your morbid curiosity you open it and find an exam with something a little odd—and a history that says something like, “Please compare to old studies which the patient brought with them.”
And you press on, and you look it over, and you start dictating, and then you realize that you really do need those previous studies. So you look in the old exam list. Disappointment. Nothing. Hm-mmm, where are they?
Now comes the time to be Sherlock. Hat and pipe, please. And you need a Watson, likely. Hope you have one. So, you explore the medical record. And you get tantalizing hints of the findings in half-notes from everyone. THEY’VE all seen the exam. Hmm. It’s out there. So, you look deeper. You find the report! Bingo!
More disappointment. They didn’t describe anything much, they were confused, maybe they even missed it.
OK, you call your staff. Maybe they’ve seen it. You’re 10 minutes into this by now. Couple of phone calls, a little time on hold, a few transfers. Eureka! Someone has the CDs! Where are they? Can I have them? Pretty please?
Alas, MORE disappointment. Someone from the clinician’s office grabbed them before they could be scanned in. They are back from whence they originated, with the referring clinician. !%$?&!!.
Phone call. Yes, they have them. They’ll send them down with someone. I always sidestep this; I will pick them up myself. Leave them with someone at the front desk. Just give me their name.
Well, unless you have a Watson. Every radiology department needs one, and you know yours, I hope.
I know ours. In the words of Mr. Holmes, “It is my business to know what other people do not know.”
Keep doing that good (and pretty much unreimbursed) work.
Mahalo.Back To Top
Wet Read: The radiologist as detective, part 1. Appl Radiol.
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.