Radiologists may soon be expected to disclose errors, apologize to patients

Healthcare providers are working to communicate with patients about errors more and more, hoping that well-planned disclosure and apology processes can help limit legislative action and improve care. What is radiology’s role in this growing trend? A new analysis published in Radiology explored that very topic.

“Strong cultural currents are driving radiologists inexorably toward situations where we will be required to disclose our errors to patients,” Stephen D. Brown, MD, of Boston Children’s Hospital and Harvard Medical School, and colleagues wrote. “This requirement will likely intensify as more systems establish broad initiatives around disclosure and apology and as legislative and procedural barriers are remedied. Some radiologists may wish to disclose their errors directly to patients, while others who are resistant to disclosure may soon find the expectation imposed on them by their institution.”

The push toward quality-based care has already helped radiology make significant progress in this area, the authors explained. Highlighting quality means that errors are being “recognized, shared and categorized” more regularly, which leads to more opportunities for quality improvement to take place. Tracking such will also “naturally present opportunities for providers to potentially discuss these events with patients.”

Brown et al. highlighted another key way radiology, as a specialty, is focusing on disclosing errors: its professional societies are making it a priority. The American College of Radiology, American Board of Radiology and RSNA have all adopted the Physician Charter on Medical Professionalism, for instance, which “explicitly mandates patients be informed when injuries occur due to medical errors.”

From a legal perspective, Brown and colleagues continued, developing communication and resolution programs (CRPs) can help providers avoid legislation. Researchers have found that the error isn’t always what leads to legal action—it’s how the error was handled.

“We have learned that patients are more likely to sue if they believe they have been dealt with dishonestly or opaquely after adverse events,” the authors wrote. “This adversarial environment creates a focus on individual culpability rather than mutual empowerment and system improvement.”

One notable change in recent years has been that consensus-driven guidelines are now being made available to providers, guidelines that “have made the realization of ideal communication with patients and families about harmful errors and adverse events practicable in a way not necessarily apparent even five years ago.” However, the authors added, these guidelines still cover the topic without getting as detailed as is needed. As a result, it is likely that imaging leaders will be asked to make some key decisions about the development and implementation of any policies that touch on this topic.

“Institutional executives, legal consultants, quality and safety officers, and risk managers seem likely to turn to radiology department leaders for guidance in formulating policies to address persistent radiology-specific barriers and unanswered questions as institutional disclosure and apology mechanisms proliferate nationally,” Brown and colleagues wrote. “This is similar to how radiology departments are often expected to create tailored radiology-specific solutions for institutional priorities around patient-centeredness and quality and safety. Indeed, further dialogue within the radiology community about error disclosure practices can be a natural and logical extension of discourse that has burgeoned in radiology around patient-centeredness and quality and safety.”

This means, of course, that much more discourse is necessary for the industry to move forward. What should be done if no CRP is yet in place? What kind of training to radiologists need? If errors are to be disclosed to a patient, what should that look like? Who should be present?

“Radiologists advancing this discussion now will help the profession proactively develop a set of best practices,” the authors concluded. “Radiologists with expertise in patient-centered care, quality, and safety are well positioned to lead the discourse, given that communicating with patients and families about adverse events and errors is a natural expression of priorities within these domains.”