When you get frustrated with my interpreting a chest x-ray as “atelectasis at the right lung base, pneumonia can't be excluded,” trust me, I don’t enjoy it. But when you ask me to rule out pneumonia you leave me no choice but to tell you that pneumonia can’t be ruled out. To rule out a disease a test must have a sensitivity of 100%, meaning there should be no false negatives. ...

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Recently, I spoke with a primary care physician (PCP) about a young runner who had a syncopal episode. Because of the increasing awareness of sudden cardiac death in athletes, she had an electrocardiogram and an echocardiogram to look for structural abnormalities of the heart. The PCP was inclined to dismiss the syncope as an isolated episode. However, the echocardiogram, otherwise normal, equivocated: “possible hypertrabeculation of the left ventricular apex, consider cardiac ...

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You know that old joke. What's a radiologist's favorite plant? The hedge. Radiologists are famous for equivocating, or hedging. "Pneumonia can't be excluded, clinically correlate," or "probably a nutrient canal but a fracture can't be excluded with absolute certainty, correlate with point tenderness." Disclaiming is satisfying neither for the radiologist nor the referring physician. It confuses rather than clarifies. So one wonders why legislators have decided to codify this singularly unclinical practice ...

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