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It has been stated that the only certainty in medicine is the pervasiveness of uncertainty [1, 2]. While medicine is often viewed as a science driven by objective data, it must also be considered an art, driven by subjective and often imprecise thought. This imprecise thought often takes the form of uncertainty, which has been described as “a state of having limited knowledge where it is improbable to exactly describe existing state or future outcome” [3]. Ultimately, the underlying goal of medicine (and radiology reporting) is to impart knowledge through accurate and confident decision-making and analysis, leading to improved clinical outcomes.  While one would hope that medical decision-making is entirely based upon sound and rational use of scientific data (i.e., evidence-based medicine), this is not always the case in everyday practice. With the increasing volume and complexity of medical data and heightened productivity expectations, healthcare providers are increasingly challenged in rendering accurate and timely decisions [4, 5]. At the same time, the rapid growth of technology and scientific knowledge has paradoxically created an increase in uncertainty in medical decision-making [6]. This is especially true for radiology providers, who are often tasked with interpreting complex imaging exams in the absence of comprehensive clinical data, which in part is due to the lack of clinical and imaging information systems integration [7]. The net result is often contrary to the desired goal. Indecisive decisions are often rendered in the radiology report in an attempt to fulfill workflow expectations, which in turn can lead to increased occupational stress and additional error [8].  While this would imply that uncertainty in medicine decision-making is inherently bad, this is not necessarily true. Uncertainty does not always imply limitations on the part of the physician, but can instead be the result of insufficient, poor quality, or inconclusive data (i.e., external uncertainty). The alternative form of uncertainty is internal uncertainty, which is due to an individual’s lack of knowledge or decisiveness and implies deficiency on the part of the individual decision-maker. Both forms of uncertainty permeate medical practice and play an important role in clinical outcomes. As a result, it is important to understand the causative factors associated with uncertainty, develop effective methods for quantifying and characterizing uncertainty, and create intervention strategies to combat uncertainty related to deficient knowledge and/or decisiveness.

Using Analysis of Speech and Linguistics to Characterize Uncertainty in Radiology Reporting