Below is a letter that was never written (letter A):
Your doctor Dr. XYZ has asked me to review your chest X-ray yesterday, since you were complaining of feeling out of breath.
I have reviewed your X-ray very carefully and realized that your heart size is larger than normal and you seem to have extra water in your lungs. This may suggest a form of heart failure, and may have caused you feeling out of breath.
That said, I would strongly recommend that you follow-up with Dr. XYZ shortly and have a more in-depth conversation with him about this and other possible alternative diagnoses, as imaging alone may not offer a complete picture of your health.
If you have any question about this letter, please feel free to email me at: email@example.com.
Thanks for allowing me to be part of your healthcare team.
Below is the letter (letter B) the patient actually receives:
One view chest X-ray
Reason: Shortness of breath
There is cardiomegaly with pulmonary vascular congestion and edema. Superimposed bibasilar atelectasis/infiltrates are not excluded. There are pleural effusions bilaterally.
Probable congestive heart failure. Clinical correlation is suggested.
Lake Tahoe, 4/1/2014