Just say no to the use of no: alternative terminology for improving anatomic pathology reports

Several organizations have recently suggested several approaches to make medicine safer, including defining "never events." To date, never events have not been defined in anatomic pathology. We recently had a case in which the word "no" was left off the final diagnosis; as a result the diagnosis both made sense and was the exact opposite of what was intended. We therefore wondered if using the word "no" or "not" in the final diagnosis should be never events in pathology. We reviewed all amendments from the past 5 years and identified a total of 8 cases (0.5% of all amendments) where the words no or not were left out of the final diagnosis. One author (A.A.R.) attempted to avoid the words no and not in the final diagnosis during a 4-month period by using alternative words such as negative, benign, and unremarkable. If these words were left out, the resulting diagnosis no longer made sense. The use of no and not was reduced from 9.3% of all cases to 0.4% of all cases (P < .001). We suggest that using the words no and not are dangerous in the final diagnosis and should be classified as never events in anatomic pathology.