What happens when radiologists hedge even when certain

Associate professor of radiology at Duke University School of Medicine, Jenny Hoang, MBBS, published an article in the Journal of the American College of Radiology, outlining reasons why radiologists should not hedge when there is certainty.

There are cases where radiologists are not certain of a diagnosis and may recommend follow-up imaging. In other cases, when there is near certainty about diagnosis and no differential diagnosis, Hoang believes radiologists should convey confidence.

“Phrases that impart high confidence to readers are 'characteristic/pathognomonic,' 'consistent withor simply the diagnosis with no qualifier. Unfortunately, some radiologists too often use words and phrases such as 'likely,' 'possible,' 'may represent' and 'could represent,' even if the diagnosis is certain. Many also qualify their interpretations of normal studies with 'no definite/apparent' and 'not seen/appreciated,'" wrote Hoang.

The author notes that in both of these cases, patients could convey this as doubt when there is no doubt.

“Not communicating certainty may be due to lack of experience, fear of medicolegal liability for misdiagnosis, or just the opinion that imaging is not definitive," Hoang wrote. "However, this practice is potentially harmful. Inappropriately implying doubt when the diagnosis is definite could delay management, lead to unnecessary investigations, or waste precious physician time through unnecessary consultation between the radiologist and the referrer.”