Communicating diagnostic uncertainty in surgical pathology reports: Disparities between sender and receiver

Abstract

Surgical pathologists use a variety of phrases to communicate varying degrees of diagnostic certainty which have the potential to be interpreted differently than intended. This study sought to: (1) assess the setting, varieties and frequency of use of phrases of diagnostic uncertainty in the diagnostic line of surgical pathology reports, (2) evaluate use of uncertainty expressions by experience and gender, (3) determine how these phrases are interpreted by clinicians and pathologists, and (4) assess solutions to this communication problem. We evaluated 1500 surgical pathology reports to determine frequency of use of uncertainty terms, identified those most commonly used, and looked for variations in usage rates on the basis of case type, experience and gender. We surveyed 76 physicians at tumor boards who were asked to assign a percentage of certainty to diagnoses containing expressions of uncertainty. We found expressions of uncertainty in 35% of diagnostic reports, with no statistically significant difference in usage based on age or gender. We found wide variation in the percentage of certainty clinicians assigned to the phrases studied. We conclude that non-standardized language used in the communication of diagnostic uncertainty is a significant source of miscommunication, both amongst pathologists and between pathologists and clinicians.

Do Not Hedge When There Is Certainty

“…I read Lexa and Fessell's [1] article concerning the decline of work quality in an older colleague. I would like to offer a suggestion that might help many groups with this difficult situation.…”

“…Phrases that impart high confidence to readers are "characteristic/pathognomonic," "consistent with," or simply the diagnosis with no qualifier [1]. Unfortunately, some radiologists too often use words and phrases such as "likely," "possible," "may represent," and "could represent," even if the diagnosis is certain.…”

Communicating Uncertainty in Surgical Pathology Reports

“…1,11 The mean level of certainty for staff pathologists and pathology residents for each phrase was approximately the same for many FTC words and phrases. For example, for the phrase “we favor,” staff pathologists averaged 65 percent certainty and pathology residents averaged 67.5 percent certainty.…”

A review of medical terminology standards and structured reporting

“…A study conducted in 2014 found expressions of uncertainty in 35% of 1,500 human surgical pathology reports. 37 In the same study, authors surveyed 76 clinicians seeking a percentage of certainty to be given to expressions of uncertainty reported within diagnoses and was found to be a significant source of miscommunication. 37 Results of these 2 studies suggest that the use of checklists and defined reporting features with avoidance of certainty percentages may help reduce errors of omission and miscommunication among clinicians.…”