Malpractice watchers: Radiologists, imaging societies should bone up on the ‘science of visual perception’

Malpractice cases against radiologists should focus on whether or not the defendant’s misdiagnosis reflected a true failure to uphold the standard of care. 

What should such allegations not emphasize? Parenthetical factors like daily patient volumes or average read times. 

Further, lawsuits should not “scrutinize abnormalities than can only be seen when the experts know that the case is being tried for malpractice.”

These are the judgments of researchers at the Universities of Washington in Seattle and Texas at Austin who build their argument on two real-world legal cases. Academic Radiology published the paper online Oct. 10. [1] 

In one case the authors present for consideration, a radiologist reading a non-contrast head CT missed an intracranial bleed in a patient who’d been on blood thinners when he banged his head. After the patient died the following day, the radiologist recognized the indefensibility of his error and sought to settle with the plaintiff. During negotiations, the plaintiff’s lawyer subpoenaed the radiologist’s keystrokes from that day. 

When the digital record showed the defendant had spent an average of 0.5 seconds reading each of almost 700 head and neck CTs, the plaintiff’s attorney alleged the radiologist was “lax” in his clinical duties. The radiologist ended up paying a $2 million settlement.  

In the other case, a patient’s attorney accused a radiologist of reading “too many X-ray examinations … demonstrating a wanton disregard of patient well-being by sacrificing quality patient care for volume in order to maximize revenue.” The plaintiff sought punitive as well as compensatory damages. 

Worried that the former would not be covered by his malpractice insurance—and that his reputation would suffer by his being taken to court—the radiologist agreed to pay a $1 million settlement. 

‘The jury lacks a yardstick’ 

In their discussion, corresponding author Sagar Kulkarni and colleagues comment that accusing a radiologist is not only negligent but also lazy or greedy is often “designed to turn the jury against the defendant radiologist.”

More: 

‘The use of keystroke logging software allows prosecutors to give precise information to the jury regarding the radiologist’s workflow; however, without adequate context, this information is worse than useless. The jury lacks a yardstick by which to judge whether adequate time has been spent on a scan. Crucially, even presenting keystroke data implies that it is a valuable metric by which to determine performance, which is not the case in reality.’

The authors further note a consequential disconnect between the practice of radiology and the public’s overall perception of the profession. They state radiology is the “black box” of the hospital, underscoring that many if not most patients have never met a radiologist who interpreted their medical images. 

In reality, they contend, time-spent-per-image is better understood to be a “personal attribute that has no bearing on the quality of clinical care offered to patients.” 

“In the near-term, it is the responsibility of professional organizations in radiology to review the science of visual perception in imaging and publish position statements and white papers on this area,” Kulkarni and co-authors state. “Such documents could form the basis of standard-of-care arguments in the legal system—and would dispel erroneous assumptions on how radiologists interpret imaging.”