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Radiologist Uncertainty and the Interpretation of Screening

Department of Community and Family Medicine, Dartmouth Medical School, Hanover and Lebanon, New Hampshire

Joann G. Elmore, MD, MPH

Department of Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle

Linn A. Abraham, MS

Center for Health Studies, Group Health Cooperative, Seattle, Washington

Martha S. Gerrity, MD, PhD

Department of Internal Medicine, Oregon Health Sciences University, Portland

R. Edward Hendrick, PhD

Lynn Sage Comprehensive Breast Center, Northwestern University Medical School, Chicago, Illinois

Stephen H. Taplin, MD, MPH

Center for Health Studies, Group Health Cooperative, Seattle, Washington, Department of Family Medicine, University of Washington, Seattle

William E. Barlow, PhD

Department of Biostatistics, University of Washington, and Cancer Research and Biostatistics, Seattle

Gary R. Cutter, PhD

Center for Research Design and Statistical Methods, University of Nevada School of Medicine, Reno

Steven P. Poplack, MD

Department of Radiology, Dartmouth Medical School, Hanover and Lebanon, New Hampshire

Carl J. D’Orsi, MD

Breast Imaging Center, Emory Health Care Services, Atlanta, Georgia

Objective. To determine radiologists’ reactions to uncertainty when interpreting mammography and the extent to which radiologist uncertainty explains variability in interpretive performance. Methods. The authors used a mailed survey to assess demographic and clinical characteristics of radiologists and reactions to uncertainty associated with practice. Responses were linked to radiologists’ actual interpretive performance data obtained from 3 regionally located mammography registries. Results. More than 180 radiologists were eligible to participate, and 139 consented for a response rate of 76.8%. Radiologist gender, more years interpreting, and higher volume were associated with lower uncertainty scores. Positive predictive value, recall rates, and specificity were more affected by reactions to uncertainty than sensitivity or negative predictive value; however, none of these relationships was statistically significant. Conclusion. Certain practice factors, such as gender and years of interpretive experience, affect uncertainty scores. Radiologists’ reactions to uncertainty do not appear to affect interpretive performance.

Key Words: medical decision making • physician uncertainty • medical malpractice • mammography interpretation

Medical Decision Making, Vol. 24, No. 3, 255-264 (2004)
DOI: 10.1177/0272989X04265480


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