A picture is worth a thousand words.

Reid Losee

Ivan S. Turgenev wrote in his 1862 novel Fathers and Sons, “The drawing shows me at one glance what might be spread over ten pages in a book.1

Physician procedure reports should tell a story, about the patient – history, assessment, diagnosis, treatment, and recommendations.  Increasingly, as patients seek to gain more access to their own medical information, these reports end up in the hands of patients with no medical training and seen through the lens of anxiety while awaiting results.  Truly perplexing statements to the lay person such as “diagnosis of exclusion” can send a patient off on a wild goose chase trying to really understand the meaning – is it excluded, or is it included by process of exclusion?  To a referring physician, the answer is clear.  But the anxious patient just grows more confused.  Then add to the mix anatomical phrases such as “an 85% stenosis in the proximal LAD,” the myriad of device names, drugs, and further diagnostic and interventional procedure names, a cardiology patient and his caregiver can easily become confused reading the report.

Instead, the report can be shared in the moments when a cardiologist has the patient’s and family’s undivided and captivated attention, and can really educate the patient graphically, visually about the condition.  Further, the report can be something they bring home to look at again after the patient’s sedative, and family’s nervous adrenaline, have worn off.  If you could see from the eyes of the patient and family, which type of information would inspire you to adopt a more healthful lifestyle?

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A working group of the American College of Cardiology published a policy statement last year in which they made this very recommendation to include graphical depictions.  “Because angiography is inherently visual, documentation of angiographic findings may be provided by graphical vascular tree and structural[1] anatomy diagrams as well as by the inclusion of images in the report. The capture of these data in a graphical or image format is a highly accurate mechanism for representing angiographic findings.”2 Personally, the yellow shading you see above would very clearly tell me there is something blocking the flow of blood.  With a small explanation, the situation is clear, and the patient wants to find ways to eliminate those yellow areas.  Compare the image to the text on the right, above.  I’m embarrassed to say, I struggle to picture the actual dimension of 13 mm.  Even 82% can be a tough number for people to put into perspective.  Some students are happy with an 82%, some are horrified.  But the yellow areas in the diagram would tell me I need to do something differently for sure!

Unfortunately, not all reporting systems can support graphics or image display, and not all HIS/ EMR vendors are able to display such graphics on the reports.  For the sake of the sedated patient and anxious family who both might forget much of what the interventional cardiologist explains post-procedure, I hope that more systems can have this capability.  The next morning, they can take a fresh look at this report and understand the diagnosis and treatment plan and hopefully better comply with the guideline driven recommendations from the physician.


[1] Turgenev, Ivan, Fathers and Sons, Russia:  The Russian Messenger, 1862.

2 Timothy A. Sanborn, MD, MS, FACC, FAHA, FSCAI; James E. Tcheng, MD, FACC, FSCAI; H. Vernon Anderson, MD, FACC, FSCAI; Charles E. Chambers, MD, FACC, FSCAI; Sharon L. Cheatham, PhD, APRN; Matthew V. DeCaro, MD, FACC; Jeremy C. Durack, MD; Allen D. Everett, MD, FACC; John B. Gordon, MD, FACC; William E. Hammond, PhD; Ziyad M. Hijazi, MBBS, MPH, FACC; Vikram S. Kashyap, MD, FACS; Merrill Knudtson, MD, FRCP(C), CM; Michael J. Landzberg, MD, FACC; Marco A. Martinez-Rios, MD, FACC, FSCAI; Lisa A. Riggs, CNS; Kui Hian Sim, MBBS, FACC; David J. Slotwiner, MD, FACC; Harry Solomon; Wilson Y. Szeto, MD; Bonnie H. Weiner, MD, FACC, FSCAI; William S. Weintraub, MD, FACC, FAHA; John R. Windle, MD, FACC, “ACC/AHA/SCAI 2014 Health Policy Statement on Structured Reporting for the Cardiac Catheterization Laboratory.” Journal of the American College of Cardiology, Volume 63, Issue 23, June 2014 .


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