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I'm a radiologist and writing helps me make sense of the world.

"My method is to take the utmost trouble to find the right thing to say, and then to say it with the utmost levity" -George Bernard Shaw

Saturday, 8 May 2010

In celebration of pedantry

Do your toes curl at the tautologous use of the phrase “CT scan”? Do you rankle when someone “orders” an investigation rather than “requests” it? Have you ever said, “Where are the cows?” in response to the phrase “lung fields”? Do you think routinely letting someone else verify your reports is lazy? Do you, in part, secretly admire Channel 4’s Green Wing character Dr Alan Statham?

Now read the following:

“They tend to obsess over the minutiae of subjects, and are prone to giving long detailed expositions, and the related corrections, and may gravitate to careers in academia or science where such obsessive attention to detail is often rewarded”.

Rather than describing some of your colleagues, it is actually describing the behaviour of those with Asperger’s syndrome (or Higher Functioning Autism). Obsessive Compulsive Personality Disorder is also in part characterized by a form of pedantry with the correct following of rules, procedures and practices.

Pedantry is typically used in an insulting negative connotation, implying a personality defect. Moreover, such attention to detail is thought unnecessary and irrelevant in NHS clinical practice.

However, it is my contention that radiologists are innately pedantic and that, rather than be embarrassed by it, we should embrace it. We all want to raise our standards of practice. Surely sloppiness of thought, word and deed is consistent with poor clinical practice? The term “pedant” comes from the Latin paedagogare, "to teach", derived from Greek terms for "child" and "to lead". So, its roots are honourable.

Admittedly, there are varying degrees amongst our ranks. And it is the degree of pedantry that seems to be the key. This is summarized well in Fowler’s Modern English Usage:

"The term, then, is obviously a relative one: my pedantry is your scholarship, his reasonable accuracy, her irreducible minimum of education and someone else’s ignorance."

A touch of pedantry when it makes a clinical difference seems entirely appropriate and defensible. But how far do we go? Prof Paul Goddard, my old head of training, had a frequently espoused maxim that “radiologists should be able to explain absolutely everything on the film”. The other end of this thought spectrum is all knowledge is a personal construct; life is uncertain and greyscale; and that one cannot be truly certain of anything. I guess most of us would want to be up at PG’s end of the spectrum. Quite an undertaking, perhaps, but surely the aim of an expert radiologist.

I argue that the innate pedantry in radiology comes from our training. Our tests are ranked by their ability to be specific and sensitive. Learning curves, ROC curves, operator dependencies are part of our working culture. We are trained and paid to be experts in our clinico-pathologico-radiological knowledge as well as our visuoperceptive and psychomotor skills. Our primary medium is the written radiological report. Our opinion should be accurate as possible, in both the language and content of our reports.

I see nothing wrong with a degree of pedantry. Moreover, I am faintly proud of it. I do feel a bit embarrassed when it gets the better of me in a meeting or other public forum. A bit like wind, I suppose.

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