Physician Perspectives on Diagnostic Uncertainty in Radiographic Imaging Reports for Pulmonary Embolism: A Qualitative Study.

STUDY OBJECTIVES: To explore physicians' interpretation and decisionmaking when encountering computed tomographic pulmonary angiogram (CTPA) reports communicating diagnostic uncertainty about the presence of pulmonary embolism (PE). METHODS: We conducted semistructured interviews from February 1 to June 3, 2024 among purposively sampled emergency medicine and hospital medicine physicians in the United States. Interviews were recorded, transcribed, and analyzed in an iterative process using reflexive thematic analysis. RESULTS: We analyzed interviews from 25 emergency physicians and 17 hospitalists. The median age was 41 years and 33% identified as women. Participants were diverse in practice setting and years of practice. Central themes included a lack of organized approach to diagnostic uncertainty, a perception that empiric anticoagulation would represent "erring on the side of caution," a tendency to defer additional testing and ascertainment of diagnostic certainty to downstream decision makers, and a disinclination to engage in repeat testing due to time pressures and local culture. Although many participants expressed support for the general idea of standardized communication of diagnostic uncertainty, most resisted its quantification in the context of CTPA reports. Many voiced concern that quantification of uncertainty left them without a clear course of action. CONCLUSION: Although diagnostic uncertainty regarding the presence of PE is commonly encountered in CTPA reports, most physicians report a lack of an organized approach to this scenario, often defaulting to empiric anticoagulation and deferring additional diagnostic testing. Future efforts are needed to develop data-driven guidance for encountering diagnostic uncertainty in radiographic imaging reports for PE.