Communication and malpractice

By Michael M. Raskin, MD, MPH, JD, FACR
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Dr. Raskin is Voluntary Associate Professor of Radiology, University of Miami School of Medicine, Miami; and Legal Counsel to the Florida Radiological Society. He is also a member of the editorial board of this journal.

If you were at the annual Radiological Society of North America (RSNA) meeting this past December, you couldn't help but notice that the theme was "Communication for Better Patient Care." The President of the RSNA, Peggy Fritzsche, MD, urged her fellow radiologists to communicate more with their colleagues, their patients, and the public. With emerging technology in the field of radiology, radiologists spend more time with technology, reducing opportunities to interact and communicate with colleagues and patients. As machines handle more and more of their responsibilities, radiologists risk becoming more isolated from their patients and colleagues in their practices.

Failure to communicate is one of the greatest problems facing radiologists today. The radiologist may make a correct diagnosis but fail to communicate the results to the referring physician. The communication must be timely and appropriate and should be documented. Direct communication may be necessary in situations in which the radiologist feels that immediate patient care is indicated. This can be accomplished in person, or by telephone, to the referring physician, other healthcare provider, or an appropriate representative. If that individual cannot be reached, it is recommended that you communicate directly to the patient or responsible guardian.

In situations in which a preliminary report is rendered before the final report is prepared, any significant change between the preliminary and final interpretation should be reported directly to the referring physician, and the communication should be documented. The courts have repeatedly held that timely communication may be as important as the diagnosis itself. A radiologist cannot escape the duty to communicate immediately with the referring physician when immediate patient treatment is necessary.

The American College of Radiology Practice Guideline for Communication recommends that significant unexpected findings can now be communicated in a manner that reasonably ensures receipt of the findings. Prior to 2002, "significant unexpected findings" had to be communicated directly. Now, in most cases, an interpretive report may be reasonable to ensure communication of the findings. However, if the patient's treatment is adversely affected by lack of timely receipt of the findings, the radiologist may still be named in a lawsuit. If the radiologist maintains that his or her duty to the patient ended with the correct dictation of the report, he or she will be perceived as being cold, callous, and uncaring.

Radiologists should also recognize the potential obligations for assuming the care and treatment of patients who are self-referred. This may even require the communication of results directly to the patient as well as appropriate follow-up. In such instances, radiologists must ensure that their communications with patients are documented.

In summary, when immediate patient treatment is indicated, communicate directly, in person or by telephone, with the referring physician or other healthcare provider, and document the extent of your communication. Communication without documentation may leave you vulnerable to attack by the plaintiff's attorneys. Take the time to document your communication. Not only will this afford you the best protection, but it's the right thing to do for your patients.

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Communication and malpractice.  Appl Radiol. 

April 13, 2004

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