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What is in a date!

Dear Editor,

Through your esteemed and widely read periodical, I want to share my experience and feelings about a practical problem. To a busy reader, it may look unimportant even to be reported; I am in no doubt though, that it can lead to fatal consequences.

It is about the “date-format” that is inscribed, or written, in our documents, particularly investigations. There are two major systems of date-formats in practice the world over: the so-called UK system (dd-mm-yyyy), and the US system (mm-dd-yyyy). So, 10th December 2023 will be 10-12-2023 in the former, and 12-10-2023 in the latter. The problem arises when a machine, say an X-ray machine, is started for the first time. If it is a US-made, all its X-ray films will have the US date-format (and converse for the UK-made). There are options to change the date format to one’s choice at the start of using the machine (and afterwards too). But it is my experience that this simple maneuver is of no importance to the managers of the system.

I requested the heads of two big institutions’ radiology departments, and they didn’t do anything about it. For a simple physician like me, it does matter. (one can extrapolate these examples to writing dates on correspondence etc.)

Our conventional teaching is to compare the chest X-ray findings with the previous ones; or to follow an abnormality in subsequent X-rays. So, if an opacity on the radiograph is an old one, mostly no action is required; if it is a new lesion, however, it may have sinister consequences especially cancer. A consolidation for example in a smoker, is followed to see if it has resolved, otherwise exclusion of malignancy is required. There may be innumerable examples of similar clinical scenarios. I am sure orthopedic colleagues would like to see their patient’s fractures united on subsequent radiographs; surgeons excluding air under the diaphragm after surgery for perforation, and so on. Now just imagine two X-ray films with dates of 2-4-2023 and 5-3-2023 with the consolidation in the second one being larger.

We are often guessing if the patient’s lesion has not improved, or that the first film is in UK format and the ‘second’, in the US format (i.e. it is actually the first one) and the lesion is improving. Here, our good old teachers’ golden principles of clinical judgement being more important than the lab/imaging, comes to rescue. But, to an inexperienced physician, and many times in real life situations, unnecessary decisions or useless investigations with consequent messing of the case, can ensue. I have seen this happening; it is no rhetoric!
We as a nation are blind followers instead of leaders.

Even by the time we are happy to remain followers, at least we should decide which system we should follow! Since the birth of this nation, 75 years ago, we have been comfortable following our colonial master’s system. In the last two to three decades, the US systems have dominated the world, including us. Why don’t we decide once-for-all that we would adopt only the xyz system in our correspondence, our reports, our grammar and so on? Personally I favor the UK system as it is the one majority of our population is used to.

Dr. Sohail Akhtar,
Professor of Pulmonology,
Indus Hospital, Karachi.

*Like someone said, ‘what is in a name?’ it is not so simple to say: what is in a date?

*Addendum: An ‘ISO 8601’ format (yyyy-mm-dd) is also gaining grounds, including in UK and the US; moreover, the mix systems of date-formats are not uncommon in many countries of the world! (


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