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Radiology Discussions RSNA "Failure to Communicate" Mock Jury Trial
RSNA "Failure to Communicate" Mock Jury Trial
As stated on the RSNA website, the central question here is whether a radiologist who detects possible lung cancer on a patient's X-ray and issues a written report noting the finding and recommending a CT scan has adequately fulfilled his responsibility? Or is he obligated to verbally communicate the findings to the referring physician-or the patient?
The verdict was "Not Guilty". The jury noted that the radiologist had legally performed his duty, although he could have followed up more dilligently and prevented the 20 month period before lung cancer was diagnosed.
Some interesting points arise - I would appreciate your opinion:
- Many hospitals do not have policies dealing with the 'follow-up' process. Should hospitals ever be liable, instead of just individuals?
- Is the patient's or referring physician's confirmation of receipt of an email/fax sufficient 'follow-up'? Obviously such messages can be overlooked or mistakenly discarded, so is verbal confirmation the only 100% ethical form of 'follow-up'?
- The more time radiologists spend communicating their results reduces their time spent with other patients and the quality of care that those patients receive. Contact phone numbers do not always work etc so which priority is more important?
- How much time does it take you to relay information to patients? Share any experience you have had with any software/technology solutions that speed up this process.
Finaly thought: Anestheseologists have standardized their policies/procedures and in turn significantly reduced their lawsuits. Radiologists should do the same.
The mock trail may have shown the radiologist was not guilty but behaviors in health care should not be driven by concern of ligation. Behaviors should be driven on what is best for the patient. Very small changes to one's workflow would minimize these events if not totally eliminate them all together.
To respond to each of your questions,
1 Most Hospitals do have communication protocols for relaying critical findings. They typically require a doctor to dictate a statement into the report and also to communicate verbally. If it was dictated into the patient report why would their referring physician not be liable for not acting on that information. Do they not read the report the radiologist create?
2 I believe there has be reasonable exception on both sides. One of those being for the referring physician to read the full report of the study they ordered. As mention at the beginning of this thread behavior should not be about concern for litigation rather what is best for the patient. In my experience radiologist take the time to relay this finding verbally. The ACR have communication guidelines that radiologist follow. It might not be the same day but not 20 months later either. But it is worth mentioning, we are all human and fail safes should be in place to catch these events when we forget.
3 If you worried about spending to much time to contact physicians. You are either understaffed or need to slow down. Why not use support staff? They can push this task over to them but if it is not tracked it could still fall through the cracks. One way or another this patient had an exam schedule by a physician. And they can be tracked down. It might take more than one phone call. Teleradiology companies have assistants that are responsible with finding the doctor and either communicating the finding or connecting to them to the radiologist at the time. Maybe it is time that radiologist look at their hospital based workflow model and incorporate assistants.
4 Time can vary greatly and each physician has their own preference of how and when they would like to be contacted. Nuance has a product called Veriphy. It integrates into VR and takes the 'grunt' work out. Depending on how it is setup, it will also alert an administrator that a case has not be communicated if multiple attempts fail.
Other system offer the ability to note/mark/flag that 'this study has a critical finding' and it is up to a process to take over.
Processes are great but if not followed are not going to be effective. Auditing/evaluating these activities on a regular basis will make sure they run at top form.
