Straight talk in medical reports

by Walter Olson on September 21, 2009

Throckmorton is losing patience with pathology and radiology reports that hedge and dodge instead of laying things out straight:

Oh, I miss the days when you got a radiology report that said, “fracture right 3rd rib, no pneumothorax”. Because of frivolous lawsuits radiologists have learned to be vague, noncommittal and to pass the buck of possible litigation. So now you get a 2 page report that says “linear lucency in right 3rd rib, clinical correlation recommended, underinflated lung fields cannot exclude underlying interstitial disease and or masses. CT recommended for further evaluation, if condition warrants.” along with several other paragraphs of lawyer imposed legalmedspeak….

{ 4 comments }

1 Doc99 09.21.09 at 4:34 pm

The solution is obvious. Getting legislation passed to enact the solution is the problem.

2 B.RAD 09.21.09 at 4:57 pm

Throckmorton, you are right, it is defensive medicine. It also might be the fact of being in a dark room all day might have one see imaginary things. Welcome to Radiology. The reason the reports are like this is often the same reason the exam is ordered– shotgun approach. Often times with little or no clinical information or direction provided, radiologists must comment on all findings, real or not, because they may be real and significant. And how about when a slegdehammer to used to kill a knat; when the CT scan is obtained to look for something a plain xray would be perfectly fine-as you know, this fishing expedition will uncover incidental findings that radiologist must report as they may be a problem for the patient. Lawyers don’t understand xray artifacts, funny shadows, differential diagnoses or disease probability. Disclaimers and hedges appear on reports just like it says “contents hot” on a to go coffee cup. In residency, a professor said to write your findings as if a plaintiff’s attorney will be reading them–sad but often true. So when the onus is put on a radiologist to clear a belly or spine in a trauma case, hope you don’t take it personally when sometimes, the buck is passed back.

3 Dr. T 09.21.09 at 6:39 pm

I’m a pathologist. I’ve seen this type of non-diagnosis among pathologists, radiologists, and specialists writing consultant reports. Studies by the legal staff at the College of American Pathologists indicate that the likelihood of being sued for medical malpractice INCREASES when you use weaselly phrasing. Therefore, it is not defensive medicine, it is pseudo-defensive medicine. It is often recommended by lawyers, but it is a stupid practice.

I use much simpler phrases: these findings are diagnostic of X, these findings are consistent with Y, these findings are suggestive of Z, or these findings are inconclusive, recommend tests A and B.

4 B. RAD 09.21.09 at 10:15 pm

Dr. T:
My reports sound similar to yours.

Also, if there’s anything published by the legal staff of the study you cited, I’d like to see it.

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