MIR: Communicate with patients or face being sued

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Failure to communicate effectively in the form of a triangle involving the radiologist, the referring physician, and the patient will result in more lawsuits, delegates were warned at this month's Management in Radiology (MIR) congress in Bologna, Italy.

The courts in the U.S. have taken, and continue to take, the position it is just as much the responsibility of radiologists to ensure communication of findings to patients as it is the responsibility of referring physicians, noted Dr. Leonard Berlin, radiologist and former chairman of radiology at Skokie Hospital in Skokie, Illinois, U.S., and professor of radiology at the University of Illinois and Rush University.

"The U.S. may be a bit further along in this, but this perception has been gaining ground in other regions, including Europe," he said. "Radiologists are physicians, and the duty emerging from their doctor-patient relationship is to inform that patient."

Radiologists will be sending reports to patients in the future, either voluntarily or by legal requirement, according to Dr. Leonard Berlin.Radiologists will be sending reports to patients in the future, either voluntarily or by legal requirement, according to Dr. Leonard Berlin.

Many radiologists remain reluctant to talk to patients about their findings, but Berlin says he does so frequently. "If patients ask me what their findings mean, I tell them that the x-ray is just one little piece in the puzzle; their doctor has the other pieces and knows which therapy may be suitable."

All too often there is a failure of communication, and this is an ethical and a moral challenge; patients feel anxiety that needs to be relieved, and harm to patients needs to be avoided, he added.

"We will be sending reports to patients in the future -- voluntarily or by legal requirement," Berlin predicted. "There may well be a law at the federal level -- this is just a matter of time, tying in with the U.S. administration's accountable-care approach."

All patients are entitled to know the results of their radiology exams -- e.g., by access via Web portals. Whereas impressive advances have been made in imaging technology, communication is still at a low level. There is technology out there that can help secure the communication between the radiologist, the referring physician, and the patient, and everybody should embrace this, he pointed out.

Chicago case

Berlin recalled the case of a 9-year-old boy in Chicago who was admitted to the emergency room with fever and coughing. The emergency physician interpreted the x-ray as showing pneumonia, and the pediatrician hospitalized the boy with an antibiotics therapy. The next day, the radiologist read the image officially; in his report he wrote: yes, this is pneumonia, but I also see little cavities that point to a tuberculosis or fungus infection.

"The report went through regular channels, and nobody read it. The boy felt a little better, was sent home, but returned to the hospital a few days later much sicker," he said. "Blastomycosis was diagnosed and treatment was given, but it was too late and the boy died. A lawsuit was filed and payment was made to the family; however, the radiologist's conscience is still bothering him with this terrible avoidable calamity, which could have been avoided with a simple phone call."

Fast-changing situation

This triangle of communication is a relatively recent interpretation because until two or three decades ago, radiologists were taught the idea they would only communicate with referring physicians, he explained. It tied in with workflow: The referrer would order an examination that the radiologist carried out, the radiologist passed on his or her findings to the referrer; at that point, the radiologist had nothing further to do with the project, and the referring physician would take on the duty of communicating with the patient.

Now, this approach has changed fundamentally. Cases have come to the public's attention where communication has failed because the referrer did not receive the radiologist's report, or he/she did not take the findings into consideration and did not communicate them to the patient. In these cases, patients never received the health information generated from their examination, and as a result, more and more lawsuits have arisen.

Already, measures have been taken to confront this issue: In the year 2000, the U.S. Congress passed the Mammography Quality Standards Act (MQSA) that says every woman who has a mammogram taken must, within 30 days, receive either a copy of the report or a summary in layman's language. It is the radiology facility's duty to ensure this. The backdrop of this was that more often than not, women never heard about findings that were often abnormal. It was grassroots lobbying by women, and support by manufacturers, that helped enact the law.

At the time, radiologists as well as their peers were very upset. The peers' paternalistic attitude was "patients are mine, and I do not want any other professional to speak to them;" radiologists found the law put an additional burden on their shoulders. "However, this law was the best thing that ever happened to the women in America, and to physicians at the same time because today, there are not any more women finding out a year or two later that they have cancer and that curative therapy was delayed," Berlin emphasized.

This should be the standard procedure for all cases where exams are carried out, in particular for nonhospital facilities, continued the expert. A slow movement in the U.S. is aiming to make this happen. There is a major trend that helps advance this approach: more and more lawsuits are taken to court, and radiologists just as referrers are found guilty of negligence for such failed communication.

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