The expert eye – Navigating ambiguity in clinical breast radiology

Drawing on phenomenological concepts of embodiment and the theory of clinical judgment, we examine how radiologists navigate the inherent risk of overtesting and overdiagnosis in breast cancer screening. Based on 12 weeks of fieldwork at a breast radiology department, we explore how radiologists navigate clinical ambiguity when women are recalled for further diagnostics following an abnormal screening mammogram. Radiologists expressed a strong sense of ethical obligation and responsibility, shaped by the structural and moral expectations of the screening programme, which fostered a precautionary mindset. We show how radiologists draw on a combination of knowledge, experience, sensory input, and emotional reasoning to navigate these ethical responsibilities. This interplay of emotions, ethics, and diagnostic skill constitutes a form of embodied expertise, which we term the "expert eye". The expert eye enables radiologists to critically engage with guideline-based diagnostics and perform less defensive, context-sensitive practices in a high-stakes setting. Ultimately, we argue that this form of expertise plays a crucial role in bridging the epistemic gap of overdiagnosis and the fundamental inability to know about or predict the progression of ambiguous findings. Our analysis also highlights the complexity of managing overtesting and overtreatment in clinical practice and suggests that supporting subjectivity in medicine, through the use of the expert eye, may in fact allow clinicians to perform higher-value care.