Day on Torts
Dr. Benjamin Strong, Chief Medical Officer at vRad, has written an article on health care liability claims against radiologists. Dr. Strong “analyzed all 220 claims made against vRad radiologists between June 2017 and October 2020—applying a detailed classification taxonomy including the alleged type of miss, study type, if the standard of care was met, if communication failures contributed, settlement, and so on.”
Dr. Strong explained that “during that timeframe, [the company’s] 500+ radiologists read nearly 20 million studies and logged an error rate of just 1.3 major misses per 1,000 reads.” Back-of-the-envelope math tells us that is one malpractice claim for every 90,900 reads.
Dr. Strong’s efforts gave rise to a list of prioritized recommendations for avoiding medical malpractice in radiology.
7. Communicate critical findings through multiple channels, including the radiology report and separate phone calls.
6. Treat preliminary reads like final reads; that’s what a judge will do.
5. Viewing a case in all planes is more valuable than reviewing all priors, clinical history, lab values, contrast dose, etc.
4. Avoid long and rambling reports.
3. Beware the total reversal phenomenon.
2. Evaluate the aorta vigilantly, no matter what.
1. Establish an anatomic search pattern and always stick to it.
Dr. Strong discusses each of his recommendations in some detail. For example, on the last point, he says the following:
That brings us to the number one thing you can do to avoid a medical malpractice suit.
Even before this recent analysis, going back to the decade I spent on our Quality Assurance Committee, I can tell you the vast majority—in fact, nearly all missed findings—are the result of failing to adhere to an established search pattern for that specific procedure.
Every radiologist should develop and follow a strict, organ-by-organ checklist for every interpretation. Know precisely what you’re going to look for, look at, and comment on.
I’ve got to look at the spinal canal. I’ve got to look at the aorta. I’ve got to look at the superior mesenteric artery. That’s a big one, by the way—the most missed single entity in all the cases I reviewed.
Adhering to your search pattern is the only way, in my opinion, to avoid those errors that the next morning are so obvious, so visually conspicuous and so avoidable.
This is an interesting read for those of us who are called upon to review potential claims against radiologists.