Posted on

A Ridiculous Error In The Radiology Report: Can I Recover My Dignity?

error

At some point in our careers, we all make ridiculous report errors. In fact, I know several radiologists that collect and sort several of these “oopsies” in the hopes that one day they will create the book of their dreams. However, some of these mistakes can feel embarrassing if you are the radiologist writing the report. Worse than that, sometimes your referring clinician or patient will call you on it. It could be a simple error like an obscene typo. (the substitution of the word “fecal” for “fetus”!) Or, it could be a detail you would have never thought to mention but your clinician wanted to know. (He asked to rule out sphenoid sinus disease, and you forgot to mention the sphenoid!) Ultimately, these mistakes go on record for all the patients and clinicians. So, how do you deal with these unfortunate miscalculations? And what do you tell the clinician? As you can tell, we will answer these questions as we dedicate this post to the delicate unforeseen “oopsie” and subsequent attempt to recover your dignity!

The Three-Step Process When You Make An Error

Make A Quick Addendum

First off, luckily, you have discovered the error in the report. Perhaps, you read the old dictation or received a phone call from the secretary. Unfortunately, however, you often make the discovery a long time after signing it off. So, what do you do? Issue an addendum as soon as possible! In most clinical practices, addendums from voice recognition technology software typically get faxed to the clinician, just like the initial report. In this situation, the clinician will receive the addendum with the rest of the dictations for the day.

Guide The Doctor To The Correct Report And Follow-Up

However, issuing an addendum is not enough. Often, the clinician will not expect the fax you give as an addendum. Bottom line: it might not get read. And sometimes, the undiscovered “oopsie” may lead to inadequate follow-up, insurance problems, patient anger, or other subsequent clinical issues. Therefore, the rules of mutual respect obligate you to contact your referring physician directly by phone or in person, if possible. It’s a horrible phone call, but you must close the loop.

Profusely Apologize For The Error

Although a touchy subject, I would recommend apologizing to the clinician (or patient if necessary) for the error. More importantly, let the receiver of the error know that you have made amends by changing the report and following up with the report recommendations. Most clinicians will appreciate your effort to correct the issue with the dictation.

Can You Recover Your Dignity From An Error?

Unfortunately, I can’t give you a better answer than it depends. For ages, some may refer to you as the clinician who added a ridiculous mistake to their patient’s report, potentially giving you an unwarranted reputation. On the other hand, others will realize that you made the error as a “one-off” and will quickly forget. Regardless, we need to negotiate these pitfalls as the hazards of our profession. And most importantly, we are more likely to garner respect from our colleagues by dealing with the consequences of the “oopsie” head-on rather than lurking in the shadows, hoping the error will go away one day. So, don’t just ignore the error, so you don’t draw its attention. Instead, own your mistakes before they own you!

 

Posted on

Top 10 Common And Silly Mistakes Of Neophyte Radiology Residents

radiology residents

Each year, new radiologist residents repeat the same mistakes as their previous counterparts. These mistakes often make radiology residents feel ridiculous and appear ignorant to the emergency department physicians and hospital staff. I thought it was high time to get these common mistakes out in the open to avoid them, so you don’t have to feel ridiculous. Here we go!!!

Uterus Vs. Prostate Gland

No one ever seems to tell the neophyte radiology residents that, on occasion, enlarged prostate glands can look like uteri and vice versa. Invariably, we get a call from the downstairs physician- “How can this patient have a uterus? He is a male!!!” It happens every year. How can you prevent this from happening to you? Just look at the sex in the patient description region, silly!

Hydronephrosis Vs. Obstruction

Toward the beginning of every year, there is usually at least one resident who does not understand that hydronephrosis does not equate to urinary tract obstruction. You can get hydronephrosis (dilatation of the renal collecting system) from other causes such as reflux or congenital enlargement. So please, do not tell the physician that a patient with a dilated renal collecting system is obstructed if you see it on ultrasound. You need to do another test (renal scan or Whitaker test) to determine if hydronephrosis is related to actual mechanical urinary tract obstruction!!!

Calling A Kidney A Testicle

Often, the resident briefly looks at an ultrasound, and the images may be very nondescript- easily mistaking a kidney for a testicle. You may have no idea what the technologist is looking at unless you make a concerted effort to read the ultrasound technologist captions/notes. I can’t tell you how many times a resident breaks this cardinal rule, especially as a first-year resident. Don’t leave the clinician up in the air wondering what kind of radiologist you are. Always read the fine print!

Overcalling Plain Film Artifacts As Radiology Residents

I can’t tell you how many times I’ve seen first-year residents intricately describe plain film findings that seem to appear on film after film. Mainly, I remember one cartridge with the same ring-like finding producing film findings time after time. Some residents thought the patient ate something strange, and others thought there was a foreign body. If you see the same markings on many films in a row, think artifact!

Not Doing A Rectal Exam Before A Barium Enema

Not performing a rectal exam is a cardinal embarrassing and uncomfortable mistake that also seems to recur every few years. Invariably, one resident forgets to do a rectal exam before inserting a rectal tube and pushes barium into the patient without checking. If you want to get yourself into trouble and perform a “vaginogram” instead of a barium enema, this is the way. Be careful!!!

Radiology Residents Calling Aortic Rupture Vs. Aneurysm Vs. Dissection

For some reason, this is a simple but important distinction that frequently seems to confuse junior/neophyte radiology residents with potentially dire consequences. Remember… Aortic rupture is a surgical emergency characterized by a breakdown of the entire wall of the aorta with free-flowing blood. An aortic aneurysm is an enlarged aorta (sometimes with increased risk of rupture) with intact walls. And, aortic dissection is a tear in the intima of the aorta with a true and false lumen. This diagnosis can sometimes be a surgical emergency, depending upon its location. Get your facts straight!!!

Calvarial Suture Vs. Fracture Confusion

The first time you are a radiology resident on call, there is a 50-50 chance you will get a pediatric head CT scan. And, you will see linear defects all over the place. I can’t tell you how many times I have seen residents overcall fractures on these studies. A. Make sure to look for symmetry of the defects… B. Look for adjacent hemorrhage C. Refer to A! If there is symmetry at the calvarial defect, it is doubtful to be a fracture. Be careful and don’t overcall!

Transverse Sinus Bleeds

Many times, neophyte residents report a dense curvilinear region to another clinician deep to the posterior calvarium and call it a subdural hemorrhage. Well, sometimes, the transverse sinus is the culprit. Look for the other sinuses and see if they merge into this region. Don’t keep the patient overnight for normal anatomy!!!

Appendix Vs. Terminal Ileum Confusion For New Radiology Residents

This is a big one. So many new radiology residents have a hard time differentiating between these two normal anatomical structures. Unfortunately, not making this distinction can sometimes be dire! An appendix is a blind-ending tube extending from the cecum. The terminal ileum is the end of the small bowel, and you can continue to follow it down to the remainder of the small bowel proximally. Don’t confuse appendicitis for terminal ileitis!!!

Calling Flow Artifact Vs. SVC Thrombus

Depending on the timing of the contrast bolus, this timing issue can lead you into trouble! Usually, where the azygous vein meets the SVC, you will get an intraluminal filling defect due to the contrast within the SVC and the non opacified blood entering the SVC from the azygous vein. A few times a year, I see residents call this defect a thrombus. This “pseudo-finding” has significant treatment implications. Don’t let that be you!!!

Establishing Credibility As Radiology Residents

These ten mistakes may seem silly or something that you might never do as a budding neophyte radiologist, but they happen every year. Avoid these ten mistakes, and you will certainly enhance your credibility. If you do not heed these ten pearls, you are doomed to repeat these cardinal mistakes lest your referring physicians will never take you seriously!