You may find your experiences change once you are/if you ever are out in the community. Perhaps in academics you don't see this as much as I do out in the community.
(1) I have clearly seen a sea change in which that statement started to appear on all reports, regardless of whether clinical correlation was needed or not. I would say the vast majority of my reports contain that statement, even for known cancers or other biopsied lesions. I even have some reports which contain statements about which particular surgery they recommend (can I please put rolly eyes here?
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Thanks...I'm sorry my rolly eyes created the misunderstanding. We all get defensive about our fields and its natural to have some conflicts when you work closely together.
(2) Surgeons and radiologists, whether they like it or not, are linked at the hip, and we are bound to have our differences.
(1) As the child of a radiologist, I discussed rads as a field pretty extensively with my dad when I first started med school. This is one of the things that really bothered him about the field; as he put it, more clinicians get more scans which may or may not be indicated, as a CYA method. This puts radiologists in an extremely vulnerable position. Their names are on a lot of charts, they are at the mercy of clinicians for referrals (they don't get to pick their patients), they can't control whether the studies ordered are the appropriate studies, they can't just say "no, I'm not reading this," and people forget that imaging studies themselves (due to technical considerations, operator skill, other factors) are simply not perfect all the time. I can remember my dad talking about partners who had been sued for reading V/Q scans on big fat obese people (i.e. poor studies) as "intermediate probability" (studies lacked obvious filling defects) when the patients in question suffered PE's days later. In one case, a radiologist was successfully sued for reading a positive PE on a helical CT (the scan was rread late in the evening, and the clinician did not bother to read the report for 3 days until the patient died of his PE). There are other storied I remember about people getting sued for missing trivial little specks on CXR's/CT's in patients that developed lung cancer 10-15+ years down the road.
Thus the current phenomenon of "No evidence of consolidation; cannot r/o small right-sided pleural effusion, pulmonary edema, or atelectasis; small nodule in RUL may represent benign mass but cannot r/o granuloma or malignancy--clinical correlation required"* instead of "No evidence of pneumonia."
I know this is hardly scientific and represents the n=1 personal experience of my dad and his particular group, and not me, but I still think it's valid as an explanation for radiologic report hedging. The point being that my father was discouraged about radiology as a field because he felt that, due to the increasingly litigious medicolegal climate, he could not render his entirely honest opinion about studies due to fear of being involved in lawsuits brought about by things beyond the control of his knowledge and skill as a physician. Radiologists, in my experience, don't hedge because they don't know the answer; they do it when they feel like they have to because people like to take advantage of them.
If I were a practicing radiologist, I would feel compelled to protect myself from the "pass-the-buck" mentality of some clinicians and the aggressive cash-grabbing attitude of med-mal attorneys. I'd hedge like crazy and not feel bad about it for a second.
(2) Very true, but I suppose familiarity can breed contempt and it's important to remember to respect our relative areas of expertise.
*Disclaimer: I am not a radiologist. I am aware that my rendering of a CXR report may sound completely ******ed to anyone with actual radiology training.
