The Right Way to Handle Errors in Radiology Practice

Any practicing radiologist will encounter the question of how to handle an error. Whether the error is cognitive (lack of knowledge or misinterpretation), technical, perceptual (true miss, did not perceive the abnormality) or communication, it is essential for the radiologist to know what to do and how to handle disclosure. This is a human process and humans are capable of errors; some errors are preventable, but not all errors can be accounted for at all times. What do you do if you recognize that you’ve made an error or the peer review committee comes to discuss an error in a case?

Legal Perspective
It is important to know the laws in your state, who should make the contact with the patient, if peer review is considered admissible in court, and what the policy is for notifying the treating physician, says Darlene King, an attorney with Saxton & Stump Lawyers and Consultants. There are also apology laws and disclosure laws-both mandatory and discretionary-in some states that are important for radiologists to understands, says Stephen D. Brown, MD, of Boston Children’s Hospital and Harvard Medical School.

Ethical Perspective
Although legal implications are usually the primary concern that enter a radiologist’s mind when an error is encountered, there are ethical questions that arise. These must be addressed in order to continue upholding the code of ethics that many professional radiologic and medical societies require for membership. Brown says radiologists need to remember that the ACP Ethics Manual states: “Errors do not necessarily constitute improper, negligent, or unethical behavior, but failure to disclose them may.”

Disclosure-when to do it
Disclosing errors can cause significant stress for both the radiologist and the patient, but most patients want full disclosure and it’s necessary to maintain trust in the physician-patient relationship, says Priscilla J. Slanetz, MD, MPH, from Beth Israel Deaconess Medical Center. However, she also emphasized that it is necessary to consider when and how a disclosure is made. For example, should the disclosure be made:

• In the written report,
• to a peer,
• to the healthcare team,
• in person to the patient with or without their family,
• or all of these, but when and in what order?

Considering the patient’s culture, cues to how much they want to know, psychological state, and expectations can help guide how to interact and disclose the error to the patient. The order of disclosures will depend on your state and institution. Overall, when talking to the patient, the disclosing radiologist should be open and empathetic-most importantly, do not “run away,” but be there to support the patient and help them understand what happened, says Slanetz.

Disclosure is an important strategy to avoiding a malpractice lawsuit, and it’s important that physicians who communicate with their patients don’t end up angering them and instead build trust and transparency, King says. Ultimately, maintaining the patient-physician trust relationship requires radiologists to enter uncomfortable conversations not to avoid lawsuits, but because it is the right thing to do, says Brown.

This discussion occurred at the Radiological Society of North America 2017 annual meeting.