Quantifying hedging

[Ludicolo]

I normally hang out in the PM&R and Gen Res forums, but this had me thinking about you guys.

So I received a memo stating that the radiologists at our institution are going to start implementing a “standardized lexicon” for their reports. If the radiographic impression is clear, then the ensuing report is straightforward. However, if there is any uncertainty regarding a diagnosis, apparently the radiologists have to now use official, mandated buzz words to tell us how uncertain they are:

>90% certainty = “consistent with”
75% = “probably” or “suspicious for”
50% = “possibly”
25% = “less likely”
<10% = “unlikely”

Communication is obviously key, and I understand the importance of using standard terminology when describing particular findings. But are these likelihood stratifications universally used and accepted? Seems like it’s based solely on individual judgment and experience, as one radiologist’s “consistent with” may be another one’s “suspicious for”. How could this “possibly” be helpful to me clinically? 😀 Or is this just CYA fodder for malpractice lawyers?

Only thing I’ve seen similar are the weekly NFL player injury reports and chances of playing. Not that I have a gambling problem or anything…

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[Shifty B]

I know they don't mean it to be, but this is accidentally funny. It's nice that they are trying to make it more decipherable to readers, but it may actually have the unintended consequence of driving people crazy. For instance, one area where this is actually done is in V/Q scans. Nothing makes people more crazy than telling them that it is an intermediate probability scan. Usually the response is something like, "Well, what am I supposed to do with that?" Then on the other hand, you have Chest CTAs, where you give a definitive answer (even though reality is not so definitive).

What do you think people will prefer?

1) There is no pulmonary embolus.

- or -

2) There likely no large central or segmental pulmonary embolus (>80% confident) and there is probably not a smaller segmental embolus (>50% confident).

By giving numbers you're actually hedging more. In the first example, you're just kind of assuming that people know those limitations.

 

[cowme]

Communication is obviously key, and I understand the importance of using standard terminology when describing particular findings. But are these likelihood stratifications universally used and accepted? Seems like it’s based solely on individual judgment and experience, as one radiologist’s “consistent with” may be another one’s “suspicious for”. How could this “possibly” be helpful to me clinically? 😀 Or is this just CYA fodder for malpractice lawyers?

Only thing I’ve seen similar are the weekly NFL player injury reports and chances of playing. Not that I have a gambling problem or anything…

It's probably more based on this than anything else you mentioned. There were some radiologists at my institution who, no matter what the case, would call it like he sees it, no matter how subtle or contradictory the findings seemed. On the other hand, some seemed to hedge every report, even if it was so apparent that me as a med student knew what was going on.

Newly minted radiologists fresh out of fellowship and those that were recently sued will hedge a hell of a lot more than the ones with 40 years under their belts without a lawsuit.