Medical Malpractice Insights: Do/should ED physicians view the imaging studies we order?

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits, a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives. If you have a story to share click here.

Chuck Pilcher, MD, FACEP

Editor, Medical Malpractice Insights

Editor, Med Mal Insights

Here’s what readers of Med Mal Insights said:

Q1: When I order a PLAIN FILM x-ray, I view the images myself:
* Always 30%
* Generally 40%
* Sometimes 29%
* Never 1%

Q2: With regard to PLAIN FlLM x-rays, I…
* Depend entirely on the radiologist’s report 9%
* Look at the images, but only for my own edification 12%
* Assess the images based on my knowledge of the clinical context 41%
* Assess the images and discuss any concerns with the radiologist 38%

Q3: When I order ADVANCED IMAGING, e.g. CT scan or MRI, I view the images myself…
* Always 14%
* Generally 29%
* Sometimes 47%
* Never 10%

Q4: When I order ADVANCED IMAGING, e.g., a CT scan or MRI, I…
* Depend entirely on the radiologist’s report 35%
* Look at the images, but only for my own edification 31%
* Assess the images based on my knowledge of the clinical context 16%
* Assess the images and discuss any concerns with the radiologist 18%

Q5: With regard to PLAIN FlLMS ONLY, the “Standard of Care” for an Emergency Physician is that images should be viewed…
Always. 28% “Four eyes are better than two.”
Often. 41% “I know what I’m looking for.”
Occasionally. 25% “It’s rarely helpful.”
Never. 6% “If radiologists make a mistake, that’s not my problem.”

Q6: With regard to ALL IMAGING that you have ordered, how often have you found something that a radiologist has missed?
* Never 3%
* Once or twice in my career 16%
* Once or twice a year 59%
* More than twice a year 22%

Q7: I would describe my level of communication with radiologists as…
* Excellent 36%
* Good 49%
* Fair 14%
* Poor 1%

Editor’s Summary:

• Emergency physicians have a significant interest in the results of the imaging we order.
• Most EP’s view plain films most of the time.
• Most EP’s rely on the radiologist to interpret advanced imaging.
• Less than 10% of respondents hold the radiologist entirely responsible for the patient’s study.
• Most EP’s detect findings that the radiologist missed often enough to be a valuable second set of eyes.
• We have a generally good relationship with our radiology colleagues.
• EP’s who do not view the imaging ordered are at risk of becoming a legitimate defendant should a finding that leads to a lawsuit be missed.

Comments:

• From a Claims Management Attorney: “If you see something, definitely say something. But if you DOCUMENT that you ‘reviewed the imaging,’ and YOU ALSO miss the finding, you can be found as responsible as the radiologist.”
• From an Emergency Medicine Professor/Attending: “The chances of an ED physician being held responsible for a missed x-ray finding are minimal. The ED doc’s defense is ‘I am not a radiologist. I do not get paid to read x-rays. I am not the one accountable for the reading.’ But this troubles me, because radiologists do miss things. Some of these findings are obvious, and a conscientious ED doc looking at the images will see them and avoid a bad outcome.”