If you aren’t following emergency physician WhiteCoat’s account of his malpractice trial, you should.
During one exchange with an expert witness, here’s how he described what a radiologist routinely did at his hospital:
The radiologist that read the film had a habit of going to the surgeons the following day and asking them what they had found. He would open up a blank report so that it looked as if it was dictated at the time of the exam, but would then hold the reports as “preliminary” and finalize them after dictating in the results of the surgeries. That way it looked like he had picked up on all these small findings before anyone else knew about them.
Wow.
That’s like knowing all the answers beforehand, and really, calls into question the interpretive skill of the radiologist. Over at Better Health, blogging radiologist scan man is incensed, calling it cheating.
With the considerable pressure to “get it right,” so to speak, I wonder how many radiologists use similar tactics in their interpretations.
Related posts:
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- "Radiologists are sabotaging the practice of medicine"
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- Patients lose again: Radiologists pull out of a hospital due to malpractice insurance concerns
- Hillary Clinton on Yahoo! Answers
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- "A CT scan in hand is far better then no CT scan or biopsy at all"
{ 12 comments }
After an abdominal ultrasound my radiologist wrote in his report “note distinct liver lesions instead of “no distinct liver lesions”. Kind of a big difference which could have been resolved with a little proof reading
I agree that a radiologist dictating a report of a CT scan after the laparotomy after finding the “answer” is a problem, but I think it may be of benefit to radiologists, surgeons, and ultimately the patient if radiologists would routinely seek the “answers” from the treating surgeons to increase their diagnostic acumen. I think I remember reading somewhere (Malcolm Gladwell, I think) that radiologists tend to get worse in their diagnostic radiographic skills the further they get from their training, (whereas as surgeons get better), because they get further removed from the patient care. In other words, they won’t really know if what they were looking at on the CT really was a pancreatic malignant tumor because they don’t follow up on what the patient really had.
Kevin
If the radiologist in this story did as you say, this is clearly not the standard of care.
Only rarely would a radiologist have the time that it would take to follow surgeons or clinicians around to get enough information to make it worthwhile. Most radiologists have to provide a final report, frequent be based on incomplete and/or misleading histories, with a very rapid turnaround time.
I practiced for 15 years in a group of 85 radiologists at St. Paul Radiology and am now the Chief Medical Officer at NightHawk Radiology Services with 135 radiologists. In my experience over this time, I have never seen this occur. Many of us would have liked the luxury of being able to have this can of information prior to dictation, but again with time constraints it’s impossible. This is not to say that many times we do dictate an addendum when we find out additional information from a pathology report or surgical findings. This is an important addition for anyone who my read the report in the future.
Great blog and tweets.
Timothy V. Myers, M.D. (tweeting under TMyers_NRSCMO), TMyers@nighthawkrad.net
The radiologist is committing fraudulent misrepresentation of a document, so long as he signs and dates his documents, using the previous day’s date. The medical chart is a legal document, and anytime you add something to a dated document, you must write in the date of any information added on a date later than the one listed on the bottom. Otherwise you are declaring that all of it was written on that first date. That counts as fraud, and is illegal.
Let’s learn from our radiology colleagues. Let’s dictate our consultation reports after the diagnosis becomes established. We’ll all look like geniuses when we correctly ’suspect’ esoteric diagnoses with confidence. “Oh yes”, we can respond casually to other physicians on the case, “look’s like just another case of schistosomiasis.”
Sounds like what the radiologist is doing is ok- instead of putting “clinical correlation is advised”; he does the clinical correlation himself. He should, however, make it clear in the report what he is doing- any changes to the preliminary report should be added as an addendum.
Too hard to believe, must be very rare case given time constraits. I think there is a great educational experience on the other hand, after a few hundred of these, he will be the best radiologist around given he knows what the patient really has and what all those non specific leasions are.
Having the radiologist dictate the report after the surgical findings are known is akin to the trial lawyer’s finding fault with a physician’s course of action after the outcome is known.
I found a case locally where the medical chart was changed by a radiologist well after the fact.
They certainly can’t interpret cardiac enalargement and pacemaker lead position.
With the advent of new technology CTA, MRI/MRA, CCS etc they are suddenly experts without formal training. The usual interpretation always includes: “further studies with (fill in the blanks) recommended”.
I like Dr. Kirsch’s response. But what the heck is schistosomiasis?
Phil, your honesty is refreshing!
Thanks, Mike. Greetings.
On the topic I do feel that the patients’ images should be viewed less like some kind of historical document where you get one chance to get it right (or else) and more like a part of a process. Certainly other doctors can change their opinion two weeks after the first round of antibiotics didn’t work.I think it is perfectly OK to review previous studies and make additional comments if new info comes to light.
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