Clear, bidirectional communication is perhaps the most essential factor in the practice of medicine. This communication must take place between patient and physician, between staff and physician, and from physician to physician. When a breakdown in this chain occurs, the possibility for error is introduced and patient safety is compromised. In addition, a malfunction in communication often ends up in litigation.
"The second-highest cause of indemnification is communication error," said Dr. Leonard Berlin.
Berlin, chairman of the department of radiology at Rush North Shore Medical Center in Skokie, IL, addressed the issues and responsibilities for communication by radiologists in a presentation delivered at the American Roentgen Ray Society (ARRS) meeting in Vancouver, BC, earlier this month.
"Communication remains today a real problem," Berlin said.
It is also a two-way street, with radiologists on one side and referring physicians on the other. The radiology information chain, according to Berlin, is the perception and interpretation of the image and the communication of those perceptions to the medical record, the referring physician, and ultimately the patient.
Many radiologists still believe that their communication responsibilities end when their interpretations have been documented in the patient record, Berlin said.
"Over the last decade to decade and a half, our duty to communicate has expanded significantly," Berlin said. "In many cases we need to communicate to the referring physician, and in some cases the patients themselves."
This is of particular importance in emergent or other nonroutine clinical situations, such as findings that are discrepant with a preceding interpretation.
Berlin stressed the importance of radiologists' familiarity with the American College of Radiology's Practice Guideline for the Communication of Diagnostic Imaging Findings (available to ACR members on the association's Web site), which were revised in October last year.
"The fact of that matter is, I daresay that a much higher percentage of attorneys know what the ACR practice guidelines are than the comparable percentage of radiologists," Berlin observed.
Although the guidelines are not requirements of practice, they do hold greater import than expert witness testimony when they are admitted into evidence as part of a malpractice proceeding.
"Jurors know that expert witnesses lie," Berlin said. "However, in those cases where the written ACR practice guidelines have been introduced, the jury may not believe the expert witness, but they're going to believe a document published by the American College of Radiology."
For emergent or nonroutine clinical situations, the ACR guidelines hold that a preliminary or final diagnostic imaging report should be expedited by the diagnostic imager in a manner that reasonably ensures timely receipt of the findings, Berlin said.
"Examples requiring nonroutine communication include, but are not limited to, those situations where there's a need for immediate or urgent intervention; where the findings are discrepant from the preceding interpretation; or the findings may be seriously adverse to the patient's health and the radiologist reasonably believes that they are unexpected by the referring physician," he said.
Berlin recommended that radiologists adhere to the guidelines' advice to document all nonroutine communications and include the time and method of communication, and specifically name the person to whom the communication was made and, whenever possible, confirmation of the communication.
In cases of unexpected or serious findings, radiologists have a responsibility to communicate that information to the patient. Most of the time, the referring physician is made aware of the findings and communicates them to their patient. However, in certain situations, the radiologist may find it is appropriate to communicate directly with the patient.
"Keep in mind, if something goes wrong, it's not going to be the referring physician who gets hurt, it's going to be the patient who gets hurt," Berlin said. "And, if you're going to get sued, you're not going to get sued by the referring physician, you're going to get sued by the patient."
Berlin believes that radiologists should not shirk from this role.
"The legal duty that we owe is not to the referring physician, the legal duty is to the patient," he said. "If there's any question in the radiologist's mind about whether the patient is going to get the results of a very urgent or important finding, you can never go wrong by telling that to the patient directly."
By Jonathan S. Batchelor
AuntMinnie.com staff writer
May 26, 2006
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ACR suspends member for malpractice testimony, March 30, 2006
Doctor's bedside manner still what counts, March 22, 2006
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