Generating precise diagnostic reports from High-Resolution Computed Tomography (HRCT) is critical for clinical workflow, yet it remains a formidable challenge due to the high pathological diversity and spatial sparsity within 3D volumes. While Video Language Models (VideoLMs) have demonstrated remarkable spatio-temporal reasoning in general domains, their adaptability to domain-specific, high-volume medical interpretation remains underexplored. In this work, we present AbSteering, an abnormality-centric framework that steers VideoLMs toward precise HRCT report generation. Specifically, AbSteering introduces: (i) an abnormality-centric Chain-of-Thought scheme that enforces abnormality reasoning, and (ii) a Direct Preference Optimization objective that utilizes clinically confusable abnormalities as hard negatives to enhance fine-grained discrimination. Our results demonstrate that general-purpose VideoLMs possess strong transferability to high-volume medical imaging when guided by this paradigm. Notably, AbSteering outperforms state-of-the-art domain-specific CT foundation models, which are pretrained with large-scale CTs, achieving superior detection sensitivity while simultaneously mitigating hallucinations.