Responsibilities of a Radiologist: Acknowledging Interpretation Errors to the Patient?
The doctor-patient relationship and the trust which is expected by the patient has been discussed on this blog and others. But the question can be asked as to where the doctor-patient relationship begins and ends. One example of a professional activity where the relationships might be unclear and perhaps ambiguous is that of the radiologist who inspects and interprets (?diagnoses?) the radiologic results. The patient may have never seen the radiologist and may be even unaware of the radiologist's name or experience. When the radiologist has performed his or her duties by interpreting the film, to whom is the radiologist professionally related? The patient? Or the physician who ordered the X-ray or other exam? And what if later it is found that the radiologist has made a mistake or missed a critical diagnosis..has, for example, made an interpretation which is regarded as a false negative. If, as is currently emphasized in the medical, ethical and legal literature the importance of acknowledging medical error and offering the patient an apology at a minimum, if not also an offer of compensation as indicated, which professional should assume that responsibility? The current treating physician who may or may not have been involved in the previous diagnosis or the radiologist who may have never seen the patient but had read the film?
Here is the scenario that was presented in this month's Virtual Mentor on this subject which was then commented upon by Thomas H. Gallagher, MD, and R. James Brenner, MD in the article entitled "Disclosure and the Retrospectoscope." Please go to the link, read the commentary and then return to express your views of this case and what you think would be the right and ethical approach toward resolution. ..Maurice.
Mrs. Lee is a busy, working mother. She has raised three children, all of whom are successful attorneys, and was looking forward to retirement when she was diagnosed with breast cancer in her left breast. Her tests following surgery showed no cancer, and six months later Mrs. Lee went to a breast imaging center for a follow-up visit.
Dr. Harris reviewed old imaging studies in preparation for her meeting with Mrs. Lee. She looked at the mammogram that had been interpreted as normal by another radiologist, 18 months before Mrs. Lee was diagnosed with breast cancer. After careful examination, Dr. Harris noted a small, ill-defined density in the left breast. It was in the location where the cancer was diagnosed on the subsequent mammogram and, in retrospect, it most likely represented the cancer in an earlier stage. In her own mind, Dr. Harris believed that many radiologists, possibly even she herself, would have interpreted the mammogram as normal. She wondered whether to tell Mrs. Lee what she had seen.