Misses and Messes in Radiology

It happens to everyone sooner or later: You’re getting your work done, and a clinician calls (or physically shows up) to discuss a case that was read by one of your colleagues. The colleague isn’t there, so you inherit the case.

The clinician has already read the report and reviewed the images, and has a specific question in mind - but it’s all new to you, and you’re under the gun to answer his question now, not in five to 10 minutes after you’ve had a chance to essentially do a double-read on the case. The clinician, of course, is not inclined to wait till tomorrow, or whenever your colleague will be back. This hot potato is yours to keep.

Then you see it - your colleague missed a finding. Something big, something small, something important, something probably inconsequential, whatever. But now you have to decide how to handle it. Especially if the clinician noticed the miss, and is specifically asking about it.

There’s no pretending that the finding isn’t there. Even if you had no conscience at all about doing right by the patient, you’d at least have a sense of self-preservation and recognize that the clinician would be documenting his conversation with you, so your name will be on the record and you’ll be liable for the miss, along with your colleague.

Assuming you’re human, the nature of your relationship with this colleague will surely cross your mind. If he’s a good friend or even just a decent teammate, you’ll want to do what you can to protect him from liability and/or looking bad to the clinician. You may be tempted to softpedal your description of the miss to the clinician, to make it seem like the finding was subtle or of little consequence, rather than an egregious error. If the colleague is higher up the food-chain than you, you might fear retaliation when he learns of your involvement.

If you’ve got a bad relationship with this colleague, you might be tempted to overcompensate in the other direction-making a bigger deal of the miss than is really warranted, or even gossiping to others on the team about the unforgivable gaffe. Some would not hesitate to show the miss to a superior, indulging in some character-assassination of the colleague. Or to utilize the peer-review system and the next M&M conference to make the embarrassment more public.

Hopefully, most of us can rein in our baser instincts and behave professionally. It helps to remember that everyone’s skill-set is different. We’re all capable of misses…and experience a range of unpleasant emotions when we learn of our own errors, even when they don’t lead to bad patient outcomes or legal action. The colleague whose miss you’re discovering now could be handling a miss from you next week.