Terminology for our times

Editor—The acronym VOMIT, coined by Hayward,¹ should undergo the substitution of “investigational” for “imaging,” since cautions apply to such tests as urine analysis for microscopic haematuria. If more tests are performed on a normal patient, the chance of an abnormal result increases.

Requesters of tests should examine their motives, particularly in those patients with symptoms that are so common that the expectation of treatable disease is low. Requests can always be “justified,” but the motive for many is “passing the buck,” which has to stop somewhere.

Radiologists regularly assume the burden of not reporting findings that could be described as abnormal. They know they may be wrong but feel that reporting anything other than “normal” or some condition with which the clinician is comfortable by virtue of familiarity, will result in endless further examinations until the goal of absolute certainty of normality is reached. This is not achievable save by someone else assuming the uncertainty and not declaring it.

In neither of Hayward's examples was there any urgency because no action can be taken in the near future, and it is the responsibility of the doctor to make this clear. Such firmness would itself have provided some comfort, but in neither case can absolute reassurance be truthfully given in the short term.

It is not necessary or possible to exclude every diagnosis that a doctor has been able to think up, regardless of pretest likelihood. This practice is consuming an inordinate amount of resources and is no substitute for careful history and physical examination.