It's my impression that radiologists and their professional societies have generally been very diligent during recent years in collaborating with clinicians to reduce unnecessary imaging. It may be that this stems from the fact that CMS has been more closely monitoring the cost of images which can be very expensive. This focus on the part of radiologists is part of the larger effort to reduce the cost of healthcare. A recent article listed five ways that radiologists can reduce unnecessary tests (see: 5 ways radiologists can reduce unnecessary tests). These steps are listed below:
1. Speak to the referring clinician.... Ask before the imaging two simple questions. What will you do if the test is positive? What will you do if the test is negative?....
2. Don’t call pulmonary hypertension if the main pulmonary artery is > 3.1 cm on CT....The chances that you will pick up pulmonary hypertension incidentally in someone with a 3.2 cm main pulmonary artery are dwarfed by the chances of an unnecessary right heart catheterization to confirm that the pulmonary hypertension was never there....
3. Follow the ACR guidelines on the management of incidental thyroid nodules....(see: Managing Incidental Thyroid Nodules Detected on Imaging: White Paper of the ACR Incidental Thyroid Findings Committee)
4. Don’t leave the decision to follow an incidental adrenal nodule, which is overwhelmingly likely to be benign, on CT in an eighty year old to the referring clinician by saying, “MRI may be obtained if clinically indicated.” Take ownership of the decision....
5....The hedge [in radiology reports] is important, on occasion. The hedge cannot be a way of life.
Here's a precise definition for the word hedge as used in the fifth point above: to limit or qualify (something) by conditions or exceptions. The optimal radiology report is one that avoids, to the extent possible, qualifications, conditions, and exceptions. Additional insights into how to create a meaningful radiology report were provided in a 2009 article (see: Risk Management & Malpractice DefensePitfalls of the Vague Radiology Report), Below is an excerpt from it:
...[R]adiologists [are urged] to render more meaningful reports of radiologic studies, going so far as to...[suggest] that radiologists do themselves, their patients, and referring physicians a disservice when they create a vague report....A rambling description of findings without a reasonable conclusion does not add anything positive and often is perceived as an attempt to distance the interpreter from the clinical issue at hand … leaving the reader confused.
I believe that all of this advice is very relevant for pathologists and their surgical pathology reports. I would personally reinforce the following pertaining to surgical pathologists based on these ideas advocated by radiologists:
- Speak to the referring clinician whenever there is ambiguity or extreme complexity of a case.
- In reports, avoid a vague rambling discourse as well as qualifiers, conditions, and exceptions.
- Whenever possible, arrive at a reasonable and actionable conclusion in the report to guide the clinician.