UNIT XV

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UNIT XV

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In this unit we review some conversations which might take place during clinical duties. Calls are a dreadful conversational scenario for beginners since it is on calls where more real-time decision-making is required and radiological English is particularly full of acronyms, abbreviations, and radiological jargon.

If you ask an American citizen, lay in medicine, what we mean by POD and CAC, take for granted that he will not say ªpostoperative dayº and ªclear all corridorsº, respectively. Therefore, it is an irrefutable fact that both medical and radiological English are a universe of their own, and this is even more true when we talk about calls.

We have tried to compile as many ªcall terms, sentences, and colloca- tionsº as possible in just a few conversations. These sentences do not need translation or any further comments and any intermediate level English- speaking radiologist can understand them easily provided they are within the appropriate context. Read the sentences aloud and do not let them catch you off guard.

Common On-Call Sentences

· A pager goes off.

· The neuroradiologist is Q4 or Q5.

· In your next golden weekend ...

· Post-call days.

· I've just reviewed your patient's MR, and wanted to discuss the findings with you.

· I would like to obtain more information on her presentation and past surgical history.

· Thank you for contacting me regarding Mrs. McHugh's CT.

· There has been no significant interval change in the appearance of ...

· I concur with the previous report.

· The next study of choice would be ...

· ER physician.

· To order a brain MR ...

· Diagnosed with ...

· Admitted for abdominal pain.

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· Admitted for oncologic work up.

· Is Mrs. Smith having neurological symptoms?

· Is the brain MR for staging?

· To obtain it as a ªnext availableº study ...

· It is not emergent.

· I'll contact the technologist.

· Resident finishing call.

· Resident coming on call.

· There are two studies pending.

· POD 10.

· Patient's medical record number #####.

· In the ICU on D10.

· The contact person for the patient is Dr. Roos.

· Her pager number is #####.

· The technologist has called for the patient.

· Transport is on the way.

· I'll follow up on these studies.

· To page the referring physician ...

· I'm the radiologist on call.

· I want to inform you about the findings.

· There is a mass in the liver.

· Paged by clinical service.

· I am returning a page. How can I help you?

· My pager is not working properly. May I have some fresh batteries?

· Is the patient under contact precautions?

· Is the patient intubated?

· Can the patient be repositioned in the left lateral decubitus position?

· I will get some extra help to move the patient.

· I will set up the ultrasound machine.

· Fiona was signing out to Amy.

· There are just a couple of brain CTs pending.

· DNR patient (baby).

· I'm on again tonight.

· I get the weekend off.

· I'll be post-call on Tuesday and Friday.

· From then on, it's ªonlyº every third for the rest of the month.

· I got only one hit.

· I am scheduled to be on with ...

· I've woken up from my pre-call sleep.

· ªCall a code!º

· CAC in the emergency room.

· It seems like every walk-in needs a brain CT.

· That make me suspicious of ...

· The IV (line) has fallen out.

· We must replace the IV line.

· Everybody was either pre-call or post-call.

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On-Call Conversations

A pager goes off. A radiologist, a cardiologist, and an orthopedic surgeon are having dinner at the hospital cafeteria:

· ªWhose beeper (pager) is going off?º

· ªIt has to be mine; the CT technologist must have finished the brain CT I was expecting,º says the radiologist, producing his pager from his lab coat right pocket.

· ªAre you Q4 or Q5?º

· ªI am Q4.º

· ªWhere are you going on your next golden weekend, Peter?º

· ªI'm go to Spain.º

· ªWhat are the toughest days for a radiology resident, Sam?º

· ªPost-call days are probably the toughest for a resident.º

· Radiologist: ªGood morning Dr. Walker. I just reviewed your patient's MR, and wanted to discuss the findings with you ...º

· Radiologist: ªGood morning Dr. Lee. I am reviewing Mrs. Carter's abdominal US and would like to obtain more information on her presentation and past surgical history ...º

· Radiologist: ªDr Clark, thank you for contacting me regarding Mrs.

McHugh's CT. I received her prior studies from John Hopkin's Hospital and have been able to compare them with our most recent studies.

There has been no significant interval change in the appearance of the 4 cm liver lesion in segment VIII. I concur with the previous report: it could be an FNH (focal nodular hyperplasia).º

· Radiologist: ªIf the lesion in the right temporal lobe is the area of con- cern, the next study of choice would be an enhanced brain MR.º

Radiology resident on call in ER (Emergency Room). Radiologist's pager goes off. Conversation with ER physician in the emergency room (ER) at 3 a.m.:

· ER physician: ªHello, I would like to order a brain MR and CT of the abdomen and pelvis for Mrs. Smith (patient). She was recently diagnosed with lung cancer and is being admitted for abdominal pain and further oncologic workup.º

· Radiologist: ªIs Mrs. Smith having neurologic symptoms or is the brain MR for staging?º

· ER physician: ªFor staging.º

· Radiologist: ªIf patient is having no neurologic symptoms and the brain MR is requested for staging only, it is reasonable to obtain it as a 'next available' study, since it is not emergent. The CT of the abdomen and

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pelvis is appropriate, given patient's symptoms and will be done emer- gently. I will contact the CT technologist.º

Radiology resident finishing call, speaking to resident coming on call:

· Radiologist 1: ªThere are two studies pending. The first is a CT of the abdomen and pelvis on a post op patient, Mr. Johnson, who is POD 10 from a gastrectomy, with persistent fevers and elevated white count. The patient's medical record number is #####. He is located in the ICU on 10D. The contact person for the patient is Dr. Jones (the surgery resident). His pager number is #####;. The second is patient is Mrs. Simpson.

The technologist has already been contacted and has called for the pa- tients. Transport is on the way.º

· Radiologist 2: ªThanks. I'll follow up on these studies and contact Dr.

Jones with the results.º

· Radiologist 2 (upon review of CT, radiologist has paged the referring physician): ªDr. Jones, this is Dr. Miller, I am the radiologist on call.

Thank you for calling back. I have reviewed Mr. Johnson's CT and wanted to inform you of the findings. There is a mass in the liver ...º Radiology resident on call, paged by clinical service:

· Radiologist: ªThis is Dr. Miller. I am the radiologist on call. I am returning a page. How can I help you?º

· Technologist: ªDr. Petit, you didn't return a page from the cardiologist.º

· Radiologist: ªI haven't been paged in the last couple of hours.º

· Technologist: ªIs your pager working properly?º

· Radiologist: ªI'm afraid it's not working properly. Do you have some fresh batteries?º

Doing an ultrasound examination at the ICU:

· Radiologist (speaking to ICU nurse): ªGood afternoon, I am Dr. Miller.

I am here to do Mrs. Smith's (patient) abdominal ultrasound. Is the patient under contact precautions?º

· Nurse: ªYes, patient is MRSA. The yellow contact gowns and gloves are in the drawer by the entrance.º

· Radiologist: ªIs the patient intubated? Can the patient be repositioned in the left lateral decubitus position?º

· Nurse: ªYes, patient is intubated but can be turned about 30 degrees.

I will get some extra help to move the patient.º

· Radiologist: ªThank you. I will set up the ultrasound machine in the meantime.º

· At about eight o'clock Fiona was signing out to Amy in the nurse's station.

ªThere are just a couple of brain CTs pending; it's been kind of quiet.º

· ªThe brain CT was not ordered because the patient was a DNR babyº (DNR stands for ªdo not resuscitateº. DNR orders are written after care- Unit XV On Call

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ful consultation with all parties involved in the patient's care, including the child's parents.)

· ªI was on call the night before last and I'm on again tonight. I'm doing an every other night, which is fine, because I get the weekend off.º

· ªI am on on Monday and again on Wednesday so I'll be post-call on Tuesday and Thursday but from then on it's ªonlyº every third for the rest of the month.º

· ªHow was your call, Sam?º

· ªNot bad at all. I had a really easy night; I got only one hit.º

· ªI am scheduled to be on with really nice attendings during my next three calls.º

· ªFor some reason I've woken up from my pre-call sleep. I can't help thinking about my presentation on alveolar proteinosis.º

· ªCall a code! When I entered the room everybody was starting to position the patient to start CPR.º

· ªAttention, attention: CAC (clear all corridors) in the emergency room.º

· ªAnother brain CT? I can't believe it. It seems like every walk-in (every patient who comes to the emergency room) needs a brain CT.º

· ªI just reviewed the X-rays and I see multiple fractures that make me suspect child abuse.º

· ªThe IV line has fallen out. I'm afraid we must replace it.º

· ªNo radiology resident came to the party. Everybody was either pre-call or post-call.º

Additional Call Terms

· Pre-call/post-call: Day preceding or following call.

· ªQº: Denotes frequency of call. For example, ªI am Q4º means that call is taken every 4 days.

· Golden weekend: Weekend uninterrupted by call. For example, on a Q4 call schedule, a golden weekend is flanked by a Thursday and Monday call.

· Home call: Call taken from home where issues resolvable by phone are done so may require returning to the hospital for issues that require personal presence.

· In-house call: Person on call stays in the hospital for the duration of call.

· Night float: System of call where night coverage is assigned for several days in a row (usually on a weekly basis). The person on call works at night and is free of day-time responsibilities.