[1975] The Difference between What Is Said and What Is Heard: Phrases of Uncertainty in Surgical Pathology Reports

Chad J Ellermeier, Joseph Fava, Ali Amin. Rhode Island Hospital, Providence, RI

Background: The most common communication route between pathologists and clinicians is by surgical pathology report. As in many facets of medicine, surgical pathology diagnoses are not always definitive; therefore pathologists often use modifying phrases to reveal uncertainty. Studies have shown that clinicians often do not interpret pathology reports like pathologists intend. Such unintentional miscommunications could potentially cause significant medical errors.
Design: After obtaining IRB approval, a study was designed in two phases. In the first phase, an online survey was distributed nationally among pathologists with variable experience levels who were asked about their interpretation of 24 phrases using a five point scale with five representing highest certainty. The second phase of the study is to distribute a national survey for clinicians including questions carried over from the first phase. The goal of the survey is to determine and compare the level of certainty of modifying phrases among pathologists and clinicians of different subspecialties to recommend potential interventions to remedy such pitfalls.
Results: To date, 52 participants have responded to the pathologist-centered survey. Table 1 shows experience levels and types of appointments for the participants. Thus far the phrases that generate most certainty are “diagnostic of” and “represents” (86.3% (n=44) and 53.1% (n=26), respectively), while “questionable” and “equivocal” create the most uncertainty (38.8% (n=19) and 32% (n=16), respectively). 63.5% of participants believed that additional communications like interdepartmental meetings were often useful in resolving misinterpretations. The clinician-centered survey is currently distributed and awaiting data collection.

Table 1- distribution of participants
A-Training level%
In training34.6 (n=18)
In practice65.4 (n=34)
B-Practice type 
Academic84.6% (n=44)
Community based11.5% (n=6)
Industry/Government3.9% (n=2)

Conclusions: Surgical pathology reports are the major conduit of information distribution with word choice playing a very important role. This will be the first study to assess interpretation of surgical pathology reports by multiple clinical specialists. Ambiguous phrases (i.e. “suggestive of” or “suspicious for”) may not be similarly interpreted by pathologists and clinicians, and deserve further investigation to elucidate unintentional, but potentially serious, miscommunications. It may be useful to recommend standard phrases to help reduce the misunderstandings.
Category: Quality Assurance

Monday, March 4, 2013 2:15 PM

Proffered Papers: Section G, Monday Afternoon


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