Duty of Care: Should Radiologists Share Results with Patients?
It keeps getting colder outside, but things were heating up in the session “Malpractice Issues in Radiology” this morning. Speakers Leonard Berlin, MD, Harley Hammerman, MD, and Richard Taxin, MD, didn’t hesitate to stir up a bit of controversy in addressing the issue of whether radiologists should communicate the results of all outpatient studies directly to their patients. Berlin got things started with a recent overview of legal cases involving radiologists charged with “failure to communicate.” Long story short, there have been several precedents for radiologists being held accountable for a failure to communicate findings. Most recently, in Arizona in 2003, a woman underwent a nursing home’s required pre-employment physical; the radiologist reading her chest x-ray saw a possible chest lesion and sent a report to the nursing home recommending a CT. The nursing home never told the woman, and she subsequently died; when her family took the radiologist to court, their conclusion was that “we conclude that the radiologist does have such a duty . . . if there is no referring physician, or if that physician is unavailable, the duty to inform shifts to the radiologist.” Berlin explained that although this was one wee court decision, such decisions are often upheld as common law, depending on which state you live in. Jury decisions are often used to establish legal precedent, and opinions in one state can influence those in the next. “This was a watershed opinion,” he said. “It really changed the whole landscape.” Harley Hammerman, MD, of Metro Imaging in St. Louis, then presented another perspective – the business case. Metro noticed its revenue leveling off in the mid-2000s and chalked the problem up to self-referral, which, Hammerman said, Missouri’s laws are lax about. To be more competitive, Metro began offering a service it branded as OnSite Results, through which patients can decide whether they’d like to hear their preliminary results immediately following their exam. Using an online satisfaction survey, Metro learned that patients are – to put it lightly – thrilled with the new service. In fact, 37% say they came to Metro exclusively because of the service. “It gave me peace of mind . . . I felt I was in control,” one patient said. Another said, “There should be no other way.” The tone changed when Taxin took the podium. “I’m here to be the party of no,” he said. In brief, Taxin thinks that radiology puts too much at risk in giving patients results; the time the radiologist must take out of his day is too expensive, the legal issues have yet to be fully explored, and according to some rough calculations he performed, “failure to communicate” malpractice represents a pretty small portion of the overall threat to radiology from litigious patients and their families. “Now is not the time to mandate direct communication,” he concluded. “If you want to do it, that’s fine, but it shouldn’t be mandated by anyone.” Normally three speakers would mark the end of the session, but, perhaps taxed by Taxin’s words (see what I did there?), Berlin then actually re-took the podium to contest his colleague’s calculation of the financial impact of “failure to communicate” cases and to question the idea that practices can’t afford to communicate better with patients. “Nobody seems to have been bankrupted by the MQSA,” he pointed out. “There’s no question that the radiologist’s legal duty is to the patient, and I think everyone would agree that therefore our moral duty is to the patient.”