Magazine article The Exceptional Parent

On Seeing What's Not There

Magazine article The Exceptional Parent

On Seeing What's Not There

Article excerpt

Of all the medical specialties, the one that requires the eye of an eagle is the radiologist. Working in front of screens, light boxes, and panels there is no patient to ask about the pain, to ask about the fears, or to ask about how whatever "it" is has changed their lives. There are no patients; there are no clinics; there are no parents--just films to read, decipher, and decide on. The radiologist's work is all about the details, the shadowy innuendos, and the inferences of light and dark. Sure, there are brief descriptions from the referring physician, but this is not enough to inspire the radiologist to want to see the patient even if the economics of the system allowed that. Of course, reading X-rays, CT scans, MRIs, and the other Buck Rogers images is not an exact science.

The inexactitude of this science was demonstrated by a Michigan State University radiology researcher, Dr. E. James Potchen. In this research project, more than one hundred board certified radiologists were asked to read a series of 60 chest X-rays. To add to the mix he included duplicates of some of the films. These radiologists, who often provide the needed green light to wheel you to surgery, disagreed among themselves an average of 20 percent of the time. To add to the concern was the observation that when a single radiologist reread the same 60 films several days later, they changed their earlier findings from 5 to 10 percent of the time.

One "planted" X-ray was of a patient who was missing his left clavicle (collar bone). Potchen was interested in "seeing" if the radiologists were "seeing" what was missing. The ability to observe what is missing is as valuable as seeing what is there. Potchen was amazed to find that over 60 percent of the radiologists overlooked the missing bone. Dr. Jerome Groopman in his book, How Doctors Think, regards this as an exercise that "points out our natural preference for focusing on positive data and ignoring the negative."

This is not a column to encourage you to second guess the integrity of the reading of your next scans but to introduce the idea of becoming better observers of what's not there. Parents are often the epicenter of needed information to start the ball rolling in finding out what's amiss with their children. It's not just clinicians that need to hear about what you are seeing, feeling, and sensing about the things that might be red herrings in your child's development. …

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