Radiologist from Florida
COMMUNICATION IN RADIOLOGY
Although the primary reasons for radiology malpractice cases are missed diagnoses or delay of diagnosis, breakdown in communication between radiologists and ordering provider's now accounts for a growing number of malpractice cases against radiologists.
One of the first cases to address this issue was in 1966 in Indiana where a court determined that when confronted with clinically significant or urgent findings, radiologist should make direct telephone contact with the referring physician before sending out the written report because "radiologists frequently cannot depend on the clinician to read a written report".
The American College of Radiology guidelines for communication states "In emergent or other nonroutine clinical situations, the interpreting physician should expedite the delivery of a diagnostic imaging report in a manner that reasonably ensures timely receipt of the findings…Communication by telephone…is appropriate and ensures receipt of the findings".
Limitations in receipt of written reports from various studies include the fact that up to 36% of physician's receiving such reports fail to acknowledge that they have been received, up to 8% of notification alerts received by primary care physicians are not followed up due to either failure of transmission or failure of the referring physician to act, and 15% of physicians admit that they did not read radiologist reports.
New information technologies may help to obviate such difficulties and can insure that timely receipt of reporting is accomplished. However there is no set standard as to what constitutes timely.
In the case of urgent or very significant unexpected findings, immediate communication is the rule, and many practice parameters for radiology in the emergency room setting require that there be a turnaround time measured in hours - minutes, rather than days. Certainly, highly significant findings such as intracranial midline shift, intracranial hemorrhage, or ruptured aneurysm require contemporaneous communication of findings with the treating physicians. With other types of urgent abnormalities such as uncomplicated diverticulitis, the requirements are less well-defined. The adage "sooner rather than later" is always a good idea and will help to minimize finger pointing.
Two Long-standing duties are imposed on radiologists as well as all physicians:
1. Recognition that the welfare of the patient is primary and
2. Adherence to the standard of care which is a national one not a local one. Radiologists also have the additional duty of being responsible to the treating physician since that is the person who will ultimately implement therapy.
In one recent case in which a patient underwent CT scan for abdominal pain in an outpatient Hospital imaging Center, a leaking abdominal aortic aneurysm was not reported until 5 days after the study was performed. Failure of the referring physician to receive the report in a shorter time interval resulted in the patient's demise and, although the requisition did not indicate a hyperacute problem, the study results belie this and a lawsuit was initiated alleging failure of communication.
Ultimately, it is the radiologist that is responsible for timely as well as accurate reporting study findings. This is best for the patient and implementation of appropriate reporting systems to ensure that radiology reporting is received in a timely fashion is an important part of radiology practice.