Mistakes are inevitable in radiology, and even the most careful specialists face the very real risk of being implicated in a medical malpractice claim. There are ways to keep that risk to a minimum, however, according to a new analysis published in the American Journal of Roentgenology.
“We are not perfect and never will be, no matter how hard we try,” wrote author Jonathan L. Mezrich, MD, JD, department of radiology and biomedical imaging at Yale University School of Medicine in New Haven, Connecticut. “Not all missed abnormal imaging findings are clinically significant, but some are.”
Mezrich went into great detail about this topic in his analysis. One big point he shared was that radiologists should try and stick to “the five Cs” to minimize the risk of being involved in a medical malpractice claim: compassion, competence, care, communication and clarity.
By developing good patient relationships, radiologists can establish a connection and show that they are caring, compassionate caregivers. It can be difficult to develop such relationships in radiology, of course, but working to do so can decrease the likelihood that a patient files a lawsuit in the first place.
Also, if a specialist does not appear to have compassion for their patients, that does not exactly look good to a jury.
A radiologist’s competence may not be questioned in all cases, Mezrich explained, but it could certainly be scrutinized for an emergency radiologist or overnight interpretation.
“Competence issues can be minimized by practicing within the limits of one's expertise and not reading certain types of studies and modalities in which one lacks adequate training,” he wrote. “The risk inherent in these situations can also be decreased by obtaining follow-up consultation with subspecialists.”
Radiologists must proofread their radiology reports and ensure no obvious mistakes made it past them. Typos suggest sloppiness, and sloppiness suggests an unreliable performance.
“Watching for dropped words is particularly important: ‘there is no evidence of acute intracranial hemorrhage’ is very different from ‘there is evidence of acute intracranial hemorrhage,’” Mezrich wrote.
Mezrich emphasized the importance of “timely, appropriate, and most importantly, documented” communication. A radiologist may need to take a jury through their actions step by step—if they didn’t communicate with a physician, the jury may wonder how serious they were taking the patient’s care in the first place.
Evidence is absolutely crucial in negligence cases, Mezrich explained. You need evidence on your side, and as much as possible. This is where the radiology report comes in.
“The radiology report is a radiologist's opportunity to contemporaneously document what he or she saw, his or her thought process, with whom he or she consulted, and discussions he or she had,” Mezrich wrote.
To apologize, or not to apologize: that is the question
Radiologists rarely interact directly with patients, and they aren’t necessarily trained in working with distressed patients like other physicians. So should a radiologist be expected to apologize to the patient when errors occur?
“Although this information is often offered through the primary care physician who has more direct access to the patient, the ethical obligation probably rests on the physician who most directly caused the error,” Mezrich wrote. “During such communications the radiologist should show compassion (one of the five Cs), emphasizing that he or she feels badly that this happened. However, risk management personnel should be consulted before any such contact with a patient, especially before directly stating one is at fault, to blame, or language of that ilk.”
He adds that all conversations should be documented—yes, one of those five Cs—and that such documentation could later be used if a malpractice claim does occur somewhere down the line.