Nobody enjoys admitting that they got something wrong, but in recent times radiologists have come to recognize the value of sharing these experiences as a means of learning and improving future patient care.
One of the best examples I’ve seen occurred at the recent ESGAR (European Society of Gastrointestinal and Abdominal Imaging) conference in a session titled “1 case, 3 lessons”. Eight established radiologists presented a case which had not gone to plan for them, often with a sub-optimal outcome, and shared the lessons which they learned from it. There is not enough space here to do justice to the wealth of learning which the speakers demonstrated from these eight cases, but I have selected three topics to give a flavor of what was discussed.
Lesson 1. Be aware of the cognitive traps inherent in radiology reporting.
Not long ago, a statement like this would have produced blank looks among an audience of radiologists but most of us are now increasingly aware of the ways in which our own thought processes can lead us astray. Some traps are familiar – most of us will have been caught out by satisfaction of search at some point, overlooking a second important finding once we think that a case has been “solved”.
Confirmation bias can lead us to accept without sufficient question a diagnosis made on previous studies, particularly when made by a respected colleague. It turns out that we are programmed to create narratives and to stick to them, sometimes to the point of ignoring or down-playing contradictory pieces of evidence. Unfortunately, recognizing our cognitive biases does not necessarily enable us to overcome them but it has to be a good start.
Lesson 2. Beware the VIP or “special patient”.
Whether it is a member of our family, a friend or colleague at work, or even a national celebrity, most of us will be asked at some point to review images or carry out interventions on patients who are in some way “special”. There is in fact a certain kudos attached to those whose opinion is most frequently sought in this way - the “doctors’ doctor."
Despite our best intentions, it is remarkably difficult to approach such patients as if they were anyone else. As well as dealing with all the cognitive traps mentioned above, we may find that when the patient is a friend or family member, we try too hard to find a benign explanation for potentially concerning findings and adjust our interpretation or recommendations accordingly.
We may also try to avoid recommending invasive further tests or procedures. There is often pressure -- self-inflicted or external -- to cut corners in order to speed up the patient’s pathway, perhaps by using a non-standard technique or by-passing an MDT or tumor board meeting. In the mistaken belief that we are doing the very best for this patient, our efforts expose them to additional risk of harm and a sub-optimal outcome. Our best course is usually to stick to established techniques, principles and pathways, and resist as best we can the pressure to do otherwise. It’s harder than it sounds.
Lesson 3. Make sure that the people around you will speak up when they see you get something wrong.
You may be the boss, but you will still get things wrong and there are times when all of us rely on others to help us out and avoid embarrassment or worse. For the most part, we tend to hope that our propensity to make mistakes might reduce across the course of our career, but this is one trap which affects us more as we get older and more senior.
I am usually skeptical about drawing parallels between healthcare and the aviation industry but one lesson which transfers well is the finding that hierarchy in the cockpit is a recipe for trouble. Junior or less-experienced members of the team must feel able to speak up if they think they see something wrong. Creating a culture in which everyone feels able to speak up is a key professional responsibility and something to which us older radiologists need to pay increasing attention.
I very much hope that ESGAR and other societies will continue and build on sessions like this – there is no doubt that they are extremely popular with delegates. If you find this kind of thing interesting, and if you can get to the U.K., you may be interested in the RCR’s national REAL (Radiology Events and Learning) meeting, to be held this year in Liverpool in November (details on the RCR website). Expect an exploration of human fallibility and the chance to discuss related issues with like-minded radiologists who are all committed to personal growth and better care for our patients.
Dr. Giles Maskell is a consultant radiologist at Royal Cornwall Hospitals National Health Service (NHS) Trust, Truro, U.K. He is a former president of the U.K. Royal College of Radiologists. Competing interests: None declared.
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