Monday, 25 September 2017

Interpretation and Diplomacy Aspects of Authority and Mental Care in Imaging Reports

Whereas the creativity and intellectual power of the radiologist are measured against his / her written report, the value of the message will not only be judged by the precision of the medical statement. The same result can be attributed to different words. Numerous common and accidental factors exert influence on the decision on what is said and what is not said, how it is assessed and what is ignored. The less certain a diagnosis is and the less favourable its possible consequences are, the more subtleties and periphrases are to be expected within the report. The decision on the nature and the volume of the written report will not only be taken by the time of recording, but is likewise prepared by the knowledge of the patient`s history and symptoms, the personal relationship to him / her as well as by a set of conditions throughout the inspection of the images. The intuition that accompanies the information transfer in imaging diagnostics does not only explain the differences in volume and depth of diagnosis and differential diagnosis, but also the range of diagnostic and therapeutic recommendations.

The analytical performance aligned with the records of diagnostic imaging is often referred to as interpretation. However, this term describes only incompletely the enquiry that comes about by stages. It suggests to the reader that the radiologist reads a finished product like the philologist a poem or the musician a score. But the radiograph is an object, the production and quality of which is essentially influenced and the properties of which can be modified by the analyst. In addition, the examiner is determined by a series of conditions, that are more or less foreseeable, that are perceived more or less intentionally and that unfold more or less strong effects. What will finally be expressed in the record and in which words the message will be clothed, is initiated in the approaches and the surroundings of the study. Thus, the authority of the radiologist on the choice of words is challenged in each particular case one more time. The comparative reading of medical imaging reports shows, to what extent the willingness and the ability to take notice of the various challenges differ.

The broad range of the information transfer has two fundamental consequences. Firstly, it exercises an influence on the response and reaction of the recipient to the presented result. Regardless of whether the diagnostic statement is correct or only more or less appropriate, the feedback that it evokes with the questioner is shaped by the choice of words. Secondly, it controls the degree of satisfaction of the recipient with the diagnostic performance and his readiness to continue the cooperation with the radiologist on the same or another scale. Both effects are more pronounced in outpatient than in inpatient imaging diagnostics. Therefore, a change between the two modi operandi will unveil these effects especially well, indeed in both directions. 

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