Communication failure: A surefire route to malpractice court

By Kate Madden Yee, staff writer

February 16, 2010 -- What if radiologists knew that failure to communicate radiologic findings to referring physicians is a factor in 80% of malpractice lawsuits? And payment to plaintiffs in these kinds of cases averaged $1.9 million per case? Most likely, they'd ramp up their communication efforts.

Consider yourself informed: It's a much more litigious world than it used to be, according to Dr. Leonard Berlin, professor of radiology at Rush University Medical College in Chicago. If radiologists don't push to get urgent, significant, or unexpected findings into the right hands, they could find themselves in the midst of a malpractice nightmare.

"Twelve to 15 years ago, the radiologist's responsibility in terms of communication ended when the dictation was done," Berlin said. "But now, as far as the courts are concerned, radiologists have just as much responsibility for patient outcomes as referring physicians do."

Berlin urged attendees at the RSNA annual meeting in Chicago last fall to think proactively about communicating radiology findings. In fact, in nearly 60% of malpractice lawsuits involving radiologists, the referring physician had never been directly contacted with critical findings, he said.

"It's nice, in theory, to say that you sent the report to the referring doctor so he should have read it," he told "But now radiologists have to foresee problems, foresee the fact that referring physicians may not get a report that's sent by routine methods. And if radiologists aren't pushing to get the results into the right hands, they're putting themselves and patients at risk."

Chain of information

Sure, radiologists are respected by their colleagues within the medical structure. But Berlin suggests that radiologists shouldn't count on that respect when push comes to shove.

"When you survey clinicians, asking them what the role of the radiologist is, they say, 'I want an accurate report, but I don't want him to suggest additional studies,' " Berlin told "Some even say they don't need the radiologist's report, because they can read their own exams. But once there's a lawsuit, 100% of those same doctors say, 'If a radiologist had called me, I would have reacted.' "

The chain of communication starts when the image is acquired. The radiologist interprets the image and communicates those findings for the referring physician and the patient and his or her medical record.

The courts take the radiologist's responsibility very seriously, Berlin told RSNA attendees: As early as 1971, one court wrote that "Radiologists who provide indirect medical care cannot escape liability by doing no more than relaying information through ordinary hospital channels." In 1995, another court ruled that the "radiologist has an obligation to protect the patient from being misdiagnosed by relating the urgency of his findings to the referring doctor. The radiologist is not free to rely upon others to avert the danger which he created by shifting blames."

At the very least, radiologists should document everything, according to Berlin: the type of communication used to transmit the findings, the date, the time, and the names of people involved.

"A note made on a report or a log contemporaneous with the event carries great weight legally," he said. "It's just hard for the juror to be confronted with the situation that the radiologist saw something serious in the image and didn't do enough to get that information to the right people."

Special aids

A chief complaint from radiologists about communication with referring doctors is that they're hard to reach, Berlin said.

"You can spend an hour trying to reach a doctor on the phone," he said. "Most radiologists don't have time to do that."

But there are newfangled ways to facilitate communication between radiologists and referring physicians. One product allows radiologists to dictate their report into an 800-number message system; the system pages the referring physician and leaves the dictation via voicemail, in the radiologist's voice, and also makes a permanent electronic record of the call being received.

Some hospitals have their radiologists tag reports that need special communication with a particular symbol so that a clerk can ensure the report gets to the referring doctor, or they hire a special clerk to follow up key findings with the prescribing physician's office.

"It may sound expensive [to hire a full-time employee just for this purpose]," Berlin said. "But if the average indemnity in a malpractice lawsuit is $1.9 million, one lawsuit would pay for quite a few clerks."

Next up: Talking directly to patients?

A movement toward radiologists communicating critical or unexpected results directly to patients has been building slowly for more than a decade, Berlin told RSNA attendees.

  • In 1996, a study published in the American Journal of Roentgenology found that when patients were asked if they wanted radiologists to tell them normal or abnormal radiologic results, versus waiting for their own doctor, 92% of patients wanted the radiologist to communicate the results if they were normal, and 87% wanted the radiologist to tell them if the results were abnormal.

  • In 2005, the American College of Radiology (ACR) published the guideline that "diagnostic imagers have an ethical responsibility to ensure communication of unexpected or serious findings to the patient."

  • In 2008, a bill was introduced into the state legislature that would make radiologic results available to patients within 10 days of those same results being sent to the prescribing physician.

"I think all outpatient results should be given directly to the patient," Berlin said. "Every woman gets a mammography report from her screening exam within 30 days. Why can't that be a requirement for all types of exams? If patients got these direct reports, all these lawsuits could be avoided."

By Kate Madden Yee staff writer
February 16, 2010

Radiologists recommend more follow-up imaging studies, November 18, 2009

Radiologists reluctant to disclose mammography errors to patients, November 12, 2009

Healthcare system wastes up to $800 billion a year, October 27, 2009

Class-action lawsuit hits Cedars-Sinai, GE over CT dose, October 20, 2009

Obama cool to curbs on medical malpractice suits, September 16, 2009

Copyright © 2010


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