Report terminology and medical liability

[Mace1370]

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Hey guys. So over the years I have seen many different styles of how to word signed out reports. Recently, I have seen several attendings who use phrases like "consistent with" and "margins appear negative". They told me they sign out cases that way for liability reasons. As I have no actual experience was this I was curious what everyone here thought. If you sign out a case and state that "margins appear negative" when in fact there is a section with a positive margin, would this phrasing prevent you from being sued? If you sign out a case as "Consistent with adenocarcinoma" and it isn't cancer, would that prevent you from being sued? My assumption is that it wouldn't do anything to protect you. Conversely, I have heard clinicians complain about reports that hedge too much. Very interested to hear everyone's take on this!

 

[jupiterianvibe]

Youre right.
it doesnt do **** to be vague like that.
if you have doubts about something and sign it out like that the first thing youll be crossexamined on is why you didnt show it to a colleague or refer it out if you werent sure.
lots of stuff in path is subjective. in fact i would say the vast majority of it is. the bull**** about us being the gold standard is academic hubris. they promise everything yet deliver nothing.

 

[musom]

100% agree. Hedging has no protective value when the headhunters come to dine on your soul.

 

[Pathbusiness]

Consistent with, suspicious for, highly suspicious for etc are used by those who can not make a decision. These things don't help in determining liabilty if anything goes wrong.

 

[octopusprime]

Consistent with, suspicious for, highly suspicious for etc are used by those who can not make a decision. These things don't help in determining liabilty if anything goes wrong.

Please. "suspicious" and "highly suspicious" are completely valid dxs, particularly in the cyto world (see: Bethesda criteria). And aside from cyto cases there is nothing wrong with using those terms if there's a caveat to doing so, like it's a **** biopsy or poorly/incompletely-sampled lesion. Obviously you can't s/o every routine thing as "c/w", "suspicous for...", and decisiveness is ideal & doable in most cases, but there are times such diagnoses are completely appropriate & can be explained in a comment, or utilizing a descriptive/generic dx [eg. "Metastatic carcinoma, see comment"] with a comment summarizing the findings as 'most c/w...' , particularly in the setting of tumors-of-unknown-origin when one can't definitively ascertain the origin.
People acting like there is no waffling in diagnoses are either embellishing their skills via an anonymous forum or delusional.

 

[Pathbusiness]

What I meant was using these terms in straightforward cases. Believe me there are a lot of people who do that.

 

[deleted314957]

What I meant was using these terms in straightforward cases. Believe me there are a lot of people who do that.

Agree. Those terms are overused. And, the medical staff KNOWS
when they are being APPROPRIATELY ( or inappropriately) used, by whom, and when they are supercilious BS.

 

[octopusprime]

What I meant was using these terms in straightforward cases. Believe me there are a lot of people who do that.

"Consistent with acute appendicitis" ...ok yeah that's obviously ridiculous....

 

[coroner]

It's more about the pathologist feeling secure how they are phrasing their line dx. and conveying to clinicians how much margin of error they are choosing to arbitrarily give themselves. Almost zero to do with liability.

An unofficial, subjective chart of accuracy for common diagnostic descriptors when you're > 50% certain you're correct (% may vary, use at your own discretion)

"Representative of": 100% (Confidence the final dx is accurate)
"Consistent with": 99%
"Suggestive of", "Compatible w/", "Characteristic of", "Favor": 95%
"Suspicious for": 90%

At the end of the day, clinicians are going to hold you accountable regardless of which of these terms you use. Again, it's more about the pathologist feeling secure.

If uncertain, i.e. < 50% correct: "Cannot exclude", "Inconclusive", "Indeterminate", "Non-specific", "Non-diagnostic"