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Reading Images

From our Lead Surgical Contributor, Dr. Paul Sturch.

It’s amazing how memories work. Even now, years after the events in question, I can often hear the voices of mentors politely explaining that “the enemy of good is perfect!” or how, as doctors, we should always make sure that we “treat the patient, not the disease!” True enough, but hardly groundbreaking for anyone who has slogged their way through six years of medical school, and two of foundation training. I look back on these episodes fondly – but one that always sticks out in my mind above the others comes from my F1 year, when I was told that “as surgeons, we always look at the images first.”

I’m shadowing the surgical reg. on her way to review a medical patient. This isn’t the first time I’ve done this, but I haven’t worked with this particular registrar before. We arrive and, as always, I sit at the computer, bring up the PACS screen, and open the patient’s scans. However, as I open the radiologist’s report, she tells me that we should “always look at the images first”, before “anything else”. I followed her lead then, and I always follow her advice, now.

Since my F1 year, I have always made the effort to decipher the various shades of grey on CT scans, X-rays, MRI scans, and even nuclear medicine scans before having a look a the expert radiologist’s report. From the clinical history, what’s the likely diagnosis and what might the scan show? Was that grey area a pathological lymph node? Was that a phlebolith or a uretric stone? Did the patient swallow a zip or were they wearing jeans? You can always go back and have a look at the scan again after the report, and you might just learn something for next time. If you can find the radiology reporting room most radiologists will be happy to take a few minutes to discuss a case and run through the scan with you. In my experience, an interest in the subject matter and a willingness to learn is always rewarded by good advice from your colleagues – most people are flattered to be asked for their advice!

I suppose this practice of referring to the images will resonate most strongly with surgeons looking at cross sections of the abdomen on CT scans, but the principle also applies to all imaging modalities, ECGs, lung function tests, urodynamics, blood tests, and EMGs. I think it makes for better doctors all round – methodical, willing to learn, and collaborative.

Now, a good few years on from my F1, whenever I order investigations for patients, I go with them for their scan, or their echo, or their ultrasound. I find out what is involved in their case, and then review the results either by myself or with an expert, if possible. I always ask myself if the test answers the question I wanted to ask, and, finally, I read the report and see if you can learn something, or if I might have spotted something someone else missed.

Maybe you already strive to do this – or maybe now you’ll remember reading this during your F1 year and do the same as I did!


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