Waffle-Master

ED docs and radiologists have a strange relationship. For that matter, I guess most docs have a strange relationship with their radiologists. The radiologist sits in a dark cave (as opposed to the well-lit cave favored by pathologists) or at home in front of a high-resolution video monitor, reads films and scans, reports back to the ordering physician, and never sees or lays hands on the patient. They don't own stethoscopes. They are great at what they do, and, even though I read every X-ray and, increasingly, most CT scans, they are just much better at finding stuff than I'll ever be and I couldn't do what I do without them. Neither could the surgeons or the internist or the orthopedists. That being said...

The dig on the radiologists is that they are notoriously Clinton-like in their reads. For instance, I might order a CT scan to look for kidney stones and, with the report about the presence of absence of stones, the radiologist is likely to tell me about 5 or 6 other "interesting" anomalies, often termed "ditzels" or "lucencies" or "hypodensities", which I then have to explain. Any of the above might represent the early manifestations of cancer or prion associated disease so it's not something we can just blow-off.

Most are great and know what I care about, but some, well, some are not helpful at all. Some truly do represent the internationally recognized symbol of radiology, which is a weasel dressed in camouflage, sitting on a fence, next to a hedge, across the street from a bank, eating a waffle.

"Waffle-master" is a term that we give to these commitment-o-phobes. When a "waffle master" is reading films we have actually worked it out to rotate the report taking amongst our providers. It is that painful. A "waffle-master" calls a minimum of two times on all studies, and one has actually called six times to add "ditzels" and "whatnots" to an already non-diagnostic read. The burden is thereby shifted to us to explain these thingamajigs to the patient and to make sure that appropriate follow-up is arranged. Quite a trick when the follow-up recommendation is usually for a similar study to be done in three to six months and the patient is either from another town or has no primary provider. A "waffle-master" will then recommend "clinical correlation" which is just a fancy way of saying that they are hedging and all responsibility is now ours. The best we can do then is to say to the patient, "Well, it's probably nothing but could be cancer so please arrange this follow-up."

The needle-in-the-eye, however, is reserved for the poor doc coming on at 6am. If a "waffle-master" is on for rads, the bleary-eyed ED doc is sure to receive five or six reports on plain films from the prior shift where the ED doc has not seen a "ditzel" or "lucency" or "hypodensity" and he or she must pick up the phone and call the discharged patient at home and inform them that they might have, but almost certainly do not have, cancer.