In the era of modern medicine, doctors around the world have standard dictations that they repeat over and over, and radiologists are certainly not protected from this practice. The name of the game is the volume of the patient, and the quality is in the far second. With that said, doctors rely on medical assistants more than they traditionally had in the past. In most cases, the assistant doctor can read the radiology report and make a recommendation based on the results, being able to focus on keywords in relation to the diagnosis. These findings are then transmitted along with the doctor.
Traditionally, the attending physician has played a more active role in all aspects of patient care. If the radiological report did not match the actual images, the physician contacted the radiologist and the addendum would be created in the form of a matching report. Physician assistants do not have this luxury, and if most radiologists rejected a request based on a time-tested hierarchy based on academic achievement. Therefore, the addition is requested less and medical interventions are recommended based on a higher percentage of poor reports.
In the following factual case, we consider how a poor radiological report can adversely affect a patient’s clinical pathway. Middle-aged men begin to experience the onset of neck pain. After searching for chiropractors, he cannot respond positively to treatment. As pain and discomfort increase, the patient also begins to experience problems with balance and some slight incontinence when he sneezes or coughs. The surgeon directs the spine specialist.
At the initial appointment by the spinal doctor, the patient is referred to a conventional MRI, CT scan and x-ray of the neck. When the patient returns to the clinic for a subsequent meeting, he is seen by the assistant doctor. The doctor's assistant reads the radiological report, and the results of the study show that the disk C5-C6 has a disk bulge with a slight compression of the cord. The actual images are scanned by a physician assistant, and he agrees with the report. The medical assistant performs a quick physical examination and does not detect clinical radiculopathy (pain, numbness, tingling or weakness) in the upper limb. He also finds no evidence of myelopathy (positive signs based on physical examination caused by spinal cord compression) due to poor physical examination. The actual intervention (treatment of small joints on the back of the spine due to arthritic changes) and physical therapy are recommended treatments for pain in the neck.
After three months, the patient returns to the clinic. He now comes with a cane due to balance problems and wears adult diapers due to urinary and fecal incontinence. This time, the patient sees the attending physician to observe the previously recommended conservative guidance. The doctor again conducts a physical examination, but no radiculopathy is detected, however, a clinical diagnosis of myelopathy was found. The doctor looks at the same pictures as the assistant doctor, originally reviewed at the last meeting. He finds two diagnoses: which were not documented in the original radiological imaging reports. The first diagnosis is a small ring tear (rupture of the outer lining of the spinal disc) on the C5-C6 disc. The second is a change in aT2 signal (indicating pressure on the spinal cord, causing possible permanent damage) on the spinal cord at the level of the C5-C6 disc.
The attending physician urges the patient to immediately undergo surgery for a cervical fracture or immediate surgery (ACDF). The operation goes well. There are no complications, and most pain in the neck is resolved. However, balance and incontinence problems are permanent.
For the rest of this patient's life, he will always walk with a cane and be forced to rely on adult diapers. Some may argue that the negligence of this case depends solely on the attending physician and his practice. I agree that there is a great truth in this statement.
A good law firm attacked the poor care that this patient received during the initial diagnosis put forward by a spinal specialist. A large law firm will also consider the consequences incurred by its client due to poor reading by the radiologist in this case. The radiologist, in my opinion, was the catalyst for the issuance of services below the Nursing Standard. Can your law firm not be aware of this, often ignoring negligent behavior on the part of the radiologist? Most can not. Therefore, a radiologist (doctor behind the scenes) is never questioned or responsible.
