If you haven’t had a discrepancy with the covering morning radiologist as a resident on call, you either haven’t read enough cases, you are the long lost great great grandson of William Roentgen, or perhaps your name is Watson, the artificial intelligence computer, and you work for IBM!!! The truth that very few attendings seem to admit is that everyone, including attendings, will miss something every once in a while. In fact, one study reported radiologists clinically miss something important between 2-20% of the time. (1) From my experience, that number seems very high, but nonetheless, the rate is significant enough. So, when… and notice, I don’t say if… you miss something and have a discrepancy at night time, you are actually being a normal radiology resident. I would even go as far to say that you are actually fortunate, in a sense, because you didn’t miss the finding as a full-fledged attending. You have someone to back you up and hopefully, you will never miss that finding again.
The first step, of course, is to prevent the major misses. The cases you need to study leading up to taking call are the cases that are common and lead to significant morbidity and mortality. You want to literally view hundreds of different types of appendicitis, aortic ruptures, pulmonary emboli, and so on and so forth so that when the time comes for you to take call, the chance of missing the important finding is significantly decreased. Unfortunately, however, we can’t prevent all the inevitable misses, and frankly, we have to admit it to ourselves first and foremost that this will be the case.
So, what do you do when you have a significant miss? Maybe you sent a patient home with acute appendicitis or a patient with a ruptured ectopic pregnancy. Maybe you missed an early retroperitoneal bleed. In any of these cases, there are certain keys to making the discrepancy, not just another horrible encounter, but rather a learning experience that is valuable for the remainder of your career. We will go a through a few rules that you need to follow in the rest of this chapter.
The first important point is how you emotionally react to the discrepancy. It is also a life lesson. We can’t undo what is done. You need to move on… Perseverating about a miss is counterproductive at best and can cause future misses at worst. Remember, just because you made a significant miss does not mean you are or will be a horrible radiologist. So, you need to get over it. The same rules apply to questions on written exams, future failures, etc. One miss does not a radiologist make…
Make Sure To Follow-up The Patient In The Morning
When you find out about the bad news, it is bad form just to leave the department sulking, not attempting to make good on the miss that you made. Try to do what you can to make sure that the physicians in the emergency room know there was a discrepancy. Or, you may need to call the patient back yourself, if need be. Bottom line… You need to make an effort to clean up your mess. It is partially your responsibility.
Read All You Can About the Miss To Not Make the Mistake Again
Reading about the case; reviewing the films; looking at other similar cases: These are all the things you should be doing soon after the miss. This is a real opportunity to understand and fix the incomplete knowledge you had on the subject before, and, of course, to never make the same mistake again.
One of the most rewarding ways of compensating for the discrepancy is to make your fellow residents and junior residents aware of the miss. Teaching your colleagues protects them from making the same mistake that you have made. And, even better, it reinforces the knowledge you have, thereby making it much less likely that you will repeat the same mistake. Just like lightning, it rarely strikes twice!!!
Midnight discrepancies are part of the normal learning ritual for a radiology resident. It is not the discrepancy itself that is a problem. That is to be expected and is part of the normal routine residency learning experience. But rather, the issue is how you as a radiology resident learn and grow from the experience. Make the best of a tough situation!!!
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609674/ Discrepancy and Error in Radiology: Concepts, Causes, and Consequences