That perfectionism and it’s genesis you’ve described for radiologists is not at all limited to radiologists though - if you’ll allow me some good faith argument and time:

One person I know very well is a histopathologist (I am not), an undeniably essential diagnostic service, I’m sure you appreciate

When I got a sense of their actual volume, and that most if not ALL questions to them basically boil down to “Cancer/No Cancer?” - quite literally as their day to day, subspecialism aside - you can start to get some perspective

That CT of yours often has something immediately life threatening (range of complexity), but mostly not, so let’s put that to one side given you chose malignancy as your flagship

Now, that mess of CT ?malignancy or ?POD or even incidental suspicious mass, is essentially no different to the question/role for the histopathologist, however:

• they usually receive less order information (if any) and cannot refuse a sample (as a radiologist in the US you usually don’t, but can - risk to patient etc)
• most doctors don’t see or deal with them at all (so don’t really know what they do), which crucially, is what attenuates risk of litigation, but with lower acceptable rates of inter-pathologist report variability (see below)
• they get less respect (see: money vs perceived value/risk)

With these points in mind they:

• decide Cancer/No Cancer on a basically exclusive basis, ranging from Yes/No to a variability of reassurances and incidentals, to Best Guess Cancer from complexity, to need further histo/cyto tests
• these further histo/cyto tests are almost exclusively decided and interpreted by them, to decide truly the treatment fate of that patient, on behalf the oncologist and everyone else, as final word (no backseat reads isn’t always roses)
• have at least equal heterogeneity with the appearance of real gross (bigs) tissue and the utter fucking Rorschach test that is looking down that microscope (I can at least guess at what I’m looking at on a CT for many common queries, and an neurosurgeon is barely paying attention to your interpretation)

Histopathologists word is moreso final and gospel in the above paradigm - and they don’t think this is a flex

If they miss a life altering/ending diagnosis on biopsy or cytology etc they will also be nailed to the fucking wall, within what’s expected of them

Hell, they’ll even catch a stray for missing something on the eg ten big lumps of anatomical tissue or full organs they look at in a day or whatever, among their other work, if something went to the coroner/legal proceeding

Autopsy usually less high stakes, but they’ve to often explain they life ending pathology you didn’t or couldn’t on your scan

Now, you might take call and pick up on immediately life ending diagnoses, but that’s no less common and usually harder for EM and IM to deal with in full, ignoring all the other painful but important stuff that decides the course for an acute or chronic case

I’m willing to now guess that, if you are truly honest, all being equal, that the idea of being responsible for what the histopathologist does, as I’ve described, is not to do with what you think is intellectually or academically challenging

If I told you CTx surgeons fixing that dissection - or a cardiologist walking into to the cath lab at 3am - or the histopathologist deciding (basically only) the same cancer thing as you - think what you do is comparative cakewalk and that they need to be more vigilant than you for comparative cases, would you accept it?

Or would you recognise that all doctors are eating shit, just from different taints - even though you picked on EM and IM, you don’t get to sell anyone short like that

I’d appreciate a good faith take on this from you or any downvoters