A recommendation for further imaging fails most often not because it was wrong but because it was unactionable. 'Correlate clinically', 'consider further evaluation if clinically indicated' and 'further imaging may be helpful' all hand the decision back to a clinician who asked you precisely because they wanted it made.
Write the recommendation as an instruction: which examination, with or without contrast, and when. 'MRI liver with hepatocyte-specific contrast in 3 months' can be ordered, tracked, and found to be missing. 'Consider MRI' cannot. Put it in the impression, not buried in the findings, and keep it to one sentence - a recommendation that shares a paragraph with three differential diagnoses is a recommendation that will be read as a musing.
Where the finding needs action within days rather than months, the report is not the delivery mechanism. Telephone it, record who you spoke to and when, and put that line in the report as well. The audit trail is what protects the patient when the referring clinician changes over a weekend.
- Name the examination, the contrast requirement and the interval in every recommendation
- Put the recommendation in the impression as its own sentence, not inside a differential
- Drop 'correlate clinically' unless you are naming the specific correlation you want
- Telephone anything needing action within days, and record the name, time and outcome in the report
- Where you would not act on it yourself, do not write it
Why it matters
An untracked recommendation is the commonest way a correct report still ends in a missed diagnosis.
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