Tort Reform for Radiologists

If you are a radiologist and haven’t been sued, you will be. But, I don’t think we should be held liable to the same extent as the referring physicians.

I am one of those people who is fascinated by catastrophe. (Perhaps that is why I am fascinated by current healthcare developments.) I love watching the history and science channels shows about Armageddon, mega-disasters, and other end-of-the-world apocalypses.

While the shows usually concentrate on rogue asteroids, giant solar flares, and extra-galactic gamma ray bursts, I envision a much more mundane but nonetheless fatal end to intelligent life on this planet. In my nightmare, the entire population of the planet is in a giant courtroom and everyone is either suing someone, being sued, or on jury duty. No one is left to tend the crops, generate the electricity, or provide any of the myriad services required to sustain modern life.

If you are a radiologist and haven’t been sued, you will be.

With workloads exploding, clinical information hard to come by, an image-first-think-later mentality in medicine, and law schools turning out hungry lawyers at a frightening pace, malpractice suits against radiologists will almost certainly continue to increase for the foreseeable future. We are just too easy a target and not many people like us or have any clue about what we do.

That is, of course, unless my movement to remove radiologists from the malpractice crosshairs is successful.

For decades I have resisted the notion of many of our clinical colleagues that we aren’t really doctors and what we do is easy. Even the American College of Radiology has made an effort to improve our image to the public and Congress. I have preached ad nauseum to anyone who would listen that an imaging request is a request for a consultation between physicians, not just an order for a test.

The reality is that no more thought goes into requesting an imaging study than goes into ordering a CBC, vital signs, or skinny latte. Check that, I think the latte actually gets more thought: is that one pump of mocha or two? Computed Tomography has become part of the physical examination frequently preceding the actual physical examination.

The clinical information provided is usually less than helpful and frequently outright misleading or contradictory. Reason for exam states “trauma” but the technologist notes states “No history of trauma.” Reason for exam states “cough” but the technologist notes states “No chest complaints.” Reason for exam states “ventilator protocol,” but the patient doesn’t have an endotracheal tube. These happen multiple times a day and I’m sure you can add a hundred more examples.

With this in mind, maybe it’s time for me to give up on the notion that I am providing a valuable consultation to a colleague. Maybe I should just admit that I am looking at thousands of images and trying to guess what is important to the requesting physician and helpful to the patient. There is little wonder that my radiology reports are becoming somewhat terse and ambiguous. If you don’t know what you are looking for, it is hard to know if you’ve found it. I certainly don’t want to swing for the fences and risk embarrassment when the rest of the story is told.

So here is the deal. Radiologists should only be held responsible for the information available to them at the time of interpretation. We should not be held liable to the same extent as the referring physicians who should have all of the information. Our liability should be placed in context with the overall care of the patient, somewhere between a CBC and EKG. Think we can get the personal injury attorneys to sign on?