While conventional wisdom might indicate that admitting an error results in more lawsuits, in fact, the opposite is true. The University of Michigan has implemented a disclosure and resolution program, and with the program, malpractice claims have been cut in half and costs and time to settlement have been significantly reduced. It's clear that medical professionals are moving toward disclosing errors, but guidance on exactly how to disclose errors is lacking.
"We're really at a bit of our infancy in radiology on this," said Dr. Constance Lehman, PhD, from the University of Washington. Exactly what constitutes an error that should be reported needs to be discussed.
For instance, in breast imaging there's a lot of attention on false positives.
"How often do any of us do a biopsy, get the biopsy results back, and it's benign; a few radiologists look at it and say, 'I wouldn't biopsy that?' " she asked. "Are we supposed to let the patient know right away, we had some review of this and we really thought this biopsy wasn't necessary? We need to be able to define with clear guidelines when an error is an error. What do we mean by that?"
Historically, the radiologist has been more behind the scenes, without much patient interaction; however, this is changing. And that makes these conversations about errors all the more difficult, according to David M. Browning, co-director of Patient Safety and Quality Initiatives at the Institute for Professionalism and Ethical Practice, Boston Children's Hospital.
"I think in many respects the radiologist may have been somewhat invisible from the perspective of patients, which makes it difficult then when you're sitting down and trying to talk to them about something that happened, or you're then dependent on the treating physician to be the one who explains how the care in radiology took place," Browning said.
Browning agrees with Lehman's sentiment and encouraged RSNA and its leadership to take on the absence of professional guidelines.
"This is not a sort of conversation that lends itself to a cookbook, but I think practicing radiologists would really benefit from some guidance about what are best practices in this area," he said. "I think it would be a big help; it would go a long ways."
Guidelines would particularly help because, as Lehman also alluded, there are mixed messages from colleagues as to the definition of an error. "A colleague may say, 'Oh, I wouldn't have done that.' That makes it difficult to have a culture of transparency," Browning noted.
Mixed messages also come from institutions and insurers. "We hear, 'of course we want you to tell the truth to the patient, but don't say that,' or, 'you can apologize but don't admit fault.' And it makes the clinician really unsure -- what is it that I should say to the patient here?" Browning said.
In the absence of guidelines being formulated, it's important for colleagues to talk to each other, Lehman said. "I think we're in a very early phase of radiology of educating ourselves and learning from others, and developing our own programs as well."
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