Radiology: Rads must be prepared to disclose errors to patients

Radiologists are often held to the same standards of patient communication as physicians providing direct clinical care, which means radiologists are going to be expected to disclose harmful radiologic errors and should prepare for such situations, according to an article in the February issue of Radiology.

“When it comes to talking with patients about harmful errors, radiologists can no longer remain secluded in the shadows,” wrote Stephen D. Brown, MD, of the department of radiology at Children’s Hospital Boston, and colleagues.

While little attention has been paid to the specific challenges in disclosing radiologic errors, the authors noted several reasons for having open communication between radiologists and patients when it comes to unexpected errors. For starters, technology has advanced to a point that patients, through EMRs and patient portals, are obtaining quick and direct access to radiologic reports. As this becomes the norm, it’s likely that patients will expect direct contact from their radiologists for error explanations.

More guidelines regarding the reporting of medical errors have been created in recent years as well. The Joint Commission on Accreditation of Healthcare Organizations established the first national guidelines on adverse event disclosure in 2001, and more recently the National Quality Forum and the Institute for Healthcare Improvement have each issued error reporting guidelines.

A solid strategy for reporting radiologic errors also shows a commitment to patient-centered care on the part of an organization, according to the authors. It reinforces the patient-provider relationship and speaks well of the integrity of a health system. Some studies have shown that open disclosure programs might positively affect malpractice experiences.

“A culture that supports disclosure of error and open communication between doctors and their patients also supports a culture of patient safety, through increased acknowledgment and ownership of errors made,” wrote Brown et al.

Despite the benefits, there are many challenges to disclosure in radiology. Medical culture is one such barrier, as most physicians are reluctant to communicate with patients about errors, for legal reasons and otherwise. This reservation could be amplified among radiologists, who traditionally have had little face-to-face interaction with patients. One study cited by the authors found only 15 percent of breast imagers would disclose details of a mammographic error that led to delayed diagnosis.

Additionally, diagnostic imaging is not 100 percent accurate even when performed and interpreted according to guidelines, so defining an error when dealing with a study that has less than perfect sensitivity or specificity is difficult.

The authors provided a few suggestions for improving the reporting of errors in radiology:

• Guidelines: Radiology-specific guidelines for the disclosure of adverse events are needed. These guidelines should help define what constitutes a radiologic error and the process for reporting the error to patients. “Guidelines would help radiologists understand what ‘harm’ is from the patient’s perspective and would provide ethical rationale that explains when radiologists should apologize personally for errors,” wrote the authors.
• Adapting disclosure process: The disclosure of errors needs to be adapted for the unique context of radiology, and reflect the severity or complexity of the adverse event. For example, relatively minor errors could be addressed with a phone call, while more complex situations could involve a conference with a group of stakeholders, including the radiologist, patient, referring physician and hospital leadership, according to the authors.

• Training: Programs for training radiologists are needed to help build the necessary communication skills to effectively disclose errors. This could include improvised role playing exercises, web-based learning programs or educational videos that model disclosure skills.