Styling for a New Age

As our Executive Editor, Joe Jalkiewicz, frequently needs to remind me, our publication adheres to the editorial guidelines set down in the American Medical Association (AMA) Manual of Style. However, I should more accurately state that we follow most of the guidelines.

Recently, we made a deliberate decision to depart from the AMA’s recommendation to specify the age and gender of patients in our Radiological Case reports.

Our primary driver for choosing to exclude this information is to support the preservation of patient confidentiality. Many of the radiological cases we publish in Applied Radiology focus on medical imaging’s role in diagnosing uncommon, even rare, disorders.

As one can imagine in this age of the internet and social media, protecting one’s privacy often takes more than simply omitting names, addresses, and other basic information like age and gender.

Indeed, I’ve heard of cases where patients have recognized themselves in case reports appearing in the medical literature. Stating that a particular case involves a 13-year-old girl who received medical care in the geographic location of the case authors makes it far easier for the patient—along with friends, relatives, and others—to identify herself today than it would have been in the past.

Moreover, someone with nefarious intentions could potentially figure out whom a case represents. GoFundMe, Facebook groups, Make-A-Wish, etc, are wonderful organizations and terrific ways for people to connect, but they also contribute to this potential loss of confidentiality.

Patient Age

With respect to patient age, for the educational purposes of our cases, only the age range is relevant for the vast majority of conditions when a given entity occurs inside or outside its expected range. I have listed here the terms we utilize to define the age-related characteristics of patients. It is also worth noting these definitions are generally in keeping with the AMA guidelines.

• Neonate: less than 1 month of age
• Toddler: 1-3 years
• Child: 3-9 years
• Adolescent: 10-12 years
• Teen: 13-19 years
• Adult: 20-45 years
• Middle-age: 45-65 years
• Elderly: over 65 years

Some might argue that “elderly” has a pejorative connotation — the closer to elderly I get, the more I tend to agree with them — but it is important to distinguish between conditions that affect young, middle-age, and older adults. For now, we’ll stick with elderly.

Maybe once I hit that category, we’ll reconsider.

Patient Gender

As with age, we omit a patient’s gender identification from Radiological Case reports, with two exceptions. The first is when a case references a condition specific to transgender individuals, as in two review articles recently published in Applied Radiology. The second is when biological sex is directly related to the diagnosis; eg, when a given entity occurs in an uncommon population or results from an anomaly involving the genitourinary system.

Times change, and publications like ours must change along with them, not just to remain relevant, but also to fully protect the privacy of the patients — people — whose cases and conditions are presented in our pages.

By implementing this policy as our own best practice, I believe we are putting ourselves and you, our readers and contributors, ahead of the curve both professionally and culturally.