Sunday, October 9, 2011
To Err is Radiologist—by Jeff Kanne, the QA Guy
“Perfectionist” is one term that describes many if not most radiologists. By our very nature and training, we are attuned to detail. Our interpretive skills require us to integrate numerous details from imaging findings and clinical data to produce a coherent report with a useful conclusion. Thus, it is only natural that the feelings evoked by recognition of missed finding or incorrect diagnosis can be hard to digest, cutting right through our state radiologic order and bliss.
We all have made and will continue to make mistakes in our clinical practice. Many of us have reported on the wrong study or wrong patient. Most of us have mixed up left and right. Most if not all radiologists who interpret chest radiographs will miss at least one pneumothorax or a lung cancer, if not both, during our careers. If we are lucky, we will catch that elusive cancer the next day or next week or the subtle pneumothorax 20 minutes later on the follow-up study.
When confronting an interpretative error, it is probably easier to deal with one’s own mistake than that of a colleague. Many of us are fortunate enough to build strong professional relationships with our clinical colleagues, and we can rely on that relationship when we have to call to report and overlooked finding or other error of our own. While radiologists are held to a higher standard with regard to interpretation of imaging studies, most seasoned clinicians recognize that we make errors, too, even ones as simple as a small pneumothorax.
When a missed finding can become quite troublesome is when it belongs to a radiologist colleague. Radiologists tend to look out for each other, but at the same time, we have to remember that we have a duty to our patients above all. On the one hand, many “missed” findings likely have no clinical significance and probably can be passed along to the original interpreting radiologist as an educational FYI. On the other hand, dealing with a clinically significant error made by a colleague, especially one who is more senior or who maintains a certain professional repute, can be quite difficult. However, I believe that allowing the initial interpreting radiologist to review the case and to be the one to notify the referring physician is probably the best path to providing optimal patient care while maintaining a good professional relationship. This provides feedback in a constructive way and allows one’s colleague to be directly involved with the situation, hopefully avoiding or at least mitgating any sense of negativity or of going behind one’s back.
If one struggles with how to handle a senior colleague’s error, perhaps the wisdom of another experienced colleague when presented with a hypothetical situation or the actual case may help guide you. Above all, building a culture of quality improvement in your department can encourage everyone to focus on patient centered care rather than radiologist centered care. Knowing that you did the right thing for your patient should let you sleep at night…realizing that your rainbow of pens are out of order on your desk may still keep you awake.