Abstract
Histopathological reports frequently contain phrases describing the degree of uncertainty of the diagnosis. We examined the interpretations of such terms by cellular pathologists, other doctors, and medical students. 203 respondents estimated the degree of certainty they would associate with the following phrases in a cellular pathology report: the features are indicative of; raise the possibility of; are compatible with; are probably those of; are diagnostic of; are in keeping with; and are suggestive of. For all phrases assessed other than “diagnostic of”, all groups showed a wide spread in the interpreted probability. For example, the probability associated with the term “in keeping with” by individual consultant pathologists ranged from 25 to 100%. This study demonstrates that pathologists vary widely in how they interpret the meaning of phrases describing probability that are commonly used in pathology reports. We suggest that this potential risk is highlighted during pathology training.
Highlights
Uncertainty is inherent in medicine, and communicating the degree of uncertainty in diagnosis and prognosis is an important part of professional practice
This study demonstrates that there is wide variation in the interpretation by individual pathologists, medical students, and other doctors of phrases routinely used in pathology practice to describe the degree of uncertainty of a diagnosis
Where the pathologist considers the diagnosis to be as certain as is reasonable for a diagnostic test to be, it is recommended that terms that are known to be interpreted by most pathologists and clinicians as conveying a high degree of certainty with relatively low spread of interpretations are used
Summary
Uncertainty is inherent in medicine, and communicating the degree of uncertainty in diagnosis and prognosis is an important part of professional practice. An analysis of recordings of 216 consultants between clinician and patient in a university-affiliated American general medical clinic showed that 71% of consultations included expressions of uncertainty [1]. The importance of doctor-to-doctor communication regarding the extent of uncertainty in a diagnosis is no less important than that between clinician and patient. Misinterpretation of the level of diagnostic certainty may lead to inappropriate treatment, a failure to uncover alternative diagnoses, and provision of incorrect prognostic information. Given the invasive nature of some investigations, misinterpretation of the certainty of a diagnosis could lead to an unnecessary investigation with serious consequences. There is evidence that children and adults when asked on several occasions are reasonably consistent in their interpretation of the level of interpreted probability for different expressions of uncertainty; there is wide variation in such interpretations between observers [2]
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