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AJR 2003; 181:282-283
© American Roentgen Ray Society

Radiologists on Trial: Whose Fault Is It?

Jacob M. Gerend

Aurora Sheboygan Clinic Sheboygan, WI 53081

I read Dr. Berlin's "Malpractice Issues in Radiology" on a regular basis and find them interesting and sometimes helpful. However, a recurring theme, which was again touched on in the January 2003 American Journal of Roentgenology [1], bothers me more than a little. It relates to the supposed position of most radiologists that if a radiologist misses a diagnosis that, on retrospective evaluation, was present on radiographs, the miss cannot be considered anything but malpractice. This position is taken despite the fact that a certain level of human error is unavoidable, even on the part of the most conscientious radiologist.

Who fosters the idea that our work must be either error-free or malpractice? Who fosters this idea of infallibility that sets the table for trial lawyers and the like? As a whole and as individuals, are we as radiologists misleading the public and, as a result, fostering unreasonable expectations? It would seem so, in view of the previous statement. It is time for some educating—and we obviously need to begin within our own ranks. Organized radiology, including the American College of Radiology, needs to get a grip. There is no time like the present to begin.

References

  1. Berlin L. Failure to diagnose lung cancer: anatomy of a malpractice trial. AJR2003; 180:37 –45[Free Full Text]

Reply

Leonard Berlin

Rush North Shore Medical Center Skokie, IL 60076

I thank Dr. Gerend for his thoughtful and insightful letter. His questions regarding the relationship between radiographic errors and malpractice have defied, and continue to defy, simple answers—a fact that has generated frustration on the part of all radiologists. Over the years, I [1–14] and others [15] have attempted to clarify this relationship, but the fact that these questions remain unanswered testifies to the lamentable conclusion that we still don't know if, and when, the missed radiographic diagnosis constitutes malpractice.

As can be seen in my writings, I agree with Gerend that the public's expectations of radiologists' capabilities are unreasonably high. I also agree that we radiologists must, through education, bring the public's expectations to a more realistic level. At the annual meeting of the American College of Radiology in September 2002, the councilors passed a resolution calling for the College's undertaking of an educational program to discuss with the American public the indications, efficacy, benefits, and limitations of mammography. This is a beginning, but clearly more must be done.

References

  1. Berlin L. Does the "missed" radiographic diagnosis constitute malpractice? Radiology1977; 123:523 –527[Abstract]
  2. Berlin L. Is a radiographic miss malpractice? an ominous example. AJR 1983;140:1031 –1034[Free Full Text]
  3. Berlin L. Do missed radiographic diagnoses constitute malpractice? ACR Bulletin1995; 51(12):9 –10
  4. Berlin L. Perceptual errors. AJR1996; 167:587 –590[Free Full Text]
  5. Berlin L. Standard of care. AJR1998; 170:275 –278[Free Full Text]
  6. Berlin L. Missed radiographic diagnoses do not constitute negligence, Wisconsin Court of Appeals rules. ACR Bulletin 1998:54(3):20 -30
  7. Berlin L, Hendrix RW. Perceptual errors and negligence. AJR 1998;170:863 –867[Abstract/Free Full Text]
  8. Berlin L. More on standards of care. (letter) AJR 1998;171:1156 –1157[Medline]
  9. Berlin L. The missed breast cancer: perceptions and realities. AJR 1999;173:1161 –1167[Free Full Text]
  10. Berlin L. Hindsight bias. AJR2000; 175:597 –601[Free Full Text]
  11. Berlin L. Defending the "missed" radiographic diagnosis. AJR2001; 176:317 –322[Free Full Text]
  12. Berlin L. Dot size, lead time, fallibility, and impact on survival: continuing controversies in mammography. AJR2001; 176:1123 –1130[Free Full Text]
  13. Berlin L. The missed breast cancer redux: time for educating the public about the limitations of mammography? AJR2001; 176:1131 –1136[Free Full Text]
  14. Berlin L. Defending the "missed" radiographic diagnosis. (letter) AJR2001; 177:471[Free Full Text]
  15. Potchen EJ, Bisesi MA. When is it malpractice to miss lung cancer on chest radiographs? Radiology1990; 175:29 –32[Free Full Text]

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L. Berlin
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Am. J. Roentgenol., July 1, 2003; 181(1): 29 - 35.
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