Poor Radiological Interpretation The Most Overlooked Negligence in Medicine
Radiologists have developed a loophole that has shifted their accountability to the treating physician or surgeon. Patients assume their physician or surgeon interprets the MRI, CT scan, X-ray, angiography, and other testing reports. What they do not know is that the radiologist’s opinion is the information presented in the radiology report. This assumption is warranted because the patients rarely meet the radiologist nor does the treating physician or surgeon ever mention the role the radiologist plays.
In the age of modern medicine, physicians across the board have standard dictations that they repeat over and over again and radiologists are certainly not immune to this practice. The name of the game is patient volume while quality is running a distant second. With that being said, treating physicians are relying on physician assistants more than they traditionally have in the past. The physician assistant in most instances can read a radiology report and make a recommendation based on the findings by being able to focus on key words in relation to a diagnosis. These findings are then passed along to the physician.
Traditionally the treating physician had a more active role in all facets of patient care. If a radiology report did not appear to match the actual images the physician would contact the radiologist and an addendum would be created in the form of a concurring report. Physician assistants do not have that luxury and if they did most radiologists would dismiss the request based on a time-honored hierarchy based on academic achievement. Consequently, addendums are being requested less and medical interventional treatments are recommended based on a higher percentage of poor reports.
In the following factitious case we will examine how a poor radiology report can alter a patient’s clinical pathway in a negative manner. A middle-aged male begins to experience the onset of neck pain. After seeking chiropractic care he fails to respond positively to the treatment. As the pain and discomfort increase the patient also begins to experience balance problems and some minor urinary incontinence when he sneezes or coughs. A referral to a spine specialist is made by the chiropractor.
Upon the initial appointment with the spine specialist physician the patient is referred out for the usual testing MRI, CT scan, and x-rays of the neck. When the patient returns to the clinic for the follow up appointment he is seen by the physician assistant. The physician assistant reads the radiology report and the findings state there is a disc bulge at the C5-C6 disc space with minor cord compression. The actual images are scanned by the physician assistant and he agrees with the report. The physician assistant performs a quick physical examination and does not find a clinical radiculopathy (pain, numbness, tingling, or weakness) in either upper extremity. He also does not find any evidence of myelopathy (positive signs based on physical examination caused by spinal cord compression) due to a poor physical examination. Facet intervention (treatment for the small joints on the back of the spine due to arthritic changes) and physical therapy are the recommended treatments for the neck pain.
After three months the patient returns to the clinic. He is now walking with a cane due to balance problems and is wearing adult diapers due to urinary and fecal incontinence. This time the patient is seen by the treating physician for follow up to the conservative management previously recommended. The physician performs a through physical examination again a radiculopathy is not found, however, a clinical diagnosis of myelopathy is found. The physician reviews the same images that the physician assistant originally reviewed on the last appointment. He finds two diagnoses’ that were not documented on the original radiology imaging reports. The first diagnosis is a small annular tear (tear in the outer lining of the spinal disc) at the C5-C6 disc. The second is aT2 signal change (indicates pressure on the spinal cord causing possible permanent damage) on the spinal cord at the C5-C6 disc level.
The treating physician urges the patient to undergo an anterior cervical decompressive or discectomy fusion (ACDF) surgery immediately. The surgery goes well. There are no complications and the majority of the neck pain is resolved. However, the balance problems and incontinence issues are permanent.
For the rest of this patient’s life he will always walk with a cane and be forced to rely on adult diapers. Some may argue that the negligence of this case rests solely on the treating physician and his practice. I agree that there is major truth to that statement.
A good law firm would pounce on the poor care that this patient received during the initial diagnosis put forth by the spine specialist’s practice. A great law firm would also consider the ramifications suffered by his/her client due to a poor reading by the radiologist in this instance. The radiologist in my opinion was the catalyst to the dispensing of services below the Standard of Care. Could your law firm uncover this often overlooked negligent behavior on the part of the radiologist? Most cannot. Therefore, the radiologist (the physician behind the scenes) is never questioned or held accountable.
