Can't find an ordering provider? Share imaging results with the patient or risk a lawsuit

Though the primary cause for radiology malpractice cases is misdiagnosis, breakdown in communication between radiologists and ordering providers now accounts for a growing proportion of lawsuits, according to a new analysis published in Current Problems in Diagnostic Radiology.

“One of the most challenging situations radiologists face with results communication is how to proceed when a referring provider cannot be reached,” wrote Barun Aryal, MD, of the University of Washington in Seattle, and colleagues. "Attempting to contact an ordering provider’s colleague or cross-covering partner is usually the first step, but sometimes this may not be possible.”

If the ordering physician is not available to discuss the patient’s findings, what are the next steps a radiologist should take to protect against an untoward outcome?

Aryal and colleagues reviewed the medicolegal implications of radiologists communicating radiological results directly to patients. They noted multiple legal precedents that argue in favor of direct communication with the patient by the radiologist.

Daly v. United States of America concluded that the defendant, a radiologist, was responsible for communicating an abnormal chest x-ray directly to Daly, the patient and plaintiff. Incorrect findings of tuberculosis were never communicated to Daly. After patient care was delayed and Daly received further consultation and assessments, a correct diagnosis was made. However, the court opined that earlier communication would have prevented further harm to the patient, and direct radiologist-to-patient communication was not a “burdensome” duty for the radiologist.

Other cases such as Stanley v. McCarver, Betesh v. United States of America and Courteau v. Dodd came to similar conclusions that ultimately, it is the responsibility of the radiologist to directly inform a patient of abnormal findings.

“Every radiologist must ensure direct contact with a health provider for critical imaging findings as established by the American College of Radiology parameters and the legal history,” Aryal and colleagues wrote. “However, when unable to contact the primary physician despite multiple attempts we recommend contacting patients directly.”

And while direct communication with the patient offers radiologists legal protection, the authors noted it also helps to “strengthen the perspective among referring providers and patients that radiologists are physicians.”

“When a physician or midlevel provider sees our report as well as the urgent actions taken to ensure appropriate and timely care, they recognize that our efforts transcend efficient and accurate reporting to help promote the highest level of health for each of our mutual patients,” the authors concluded.