Stepping out further from the shadows: disclosure of harmful radiologic errors to patients

Voices emerging from the shadows: Radiologic practitioners' experiences of challenging conversations

OBJECTIVE

Traditionally, radiologists have practiced their profession behind the scenes. Today, radiologic practitioners face mounting expectations to communicate more directly with patients. However, their experiences with patient communication are not well understood. The aim of this study was to describe the challenges of radiologic practitioners when communicating with patients.

METHODS

Twelve day-long interprofessional communication skills workshops for radiologic clinicians were held at Boston Children's Hospital. Prior to each workshop, participants were asked to write narratives describing experiences with difficult radiologic conversations that they found particularly challenging or satisfying. The narratives were transcribed and analyzed through thematic content analysis by two researchers.

RESULTS

Radiologists, radiology trainees, technologists, nurses, and medical interpreters completed 92 narratives. The most challenging aspects of healthcare conversations included: Conveying Serious News (n=44/92; 48%); Expanded Scope of Radiologic Practice (n=37/92; 40%); Inexperience and Gaps in Education (n=15/92; 16%); Clinical Uncertainty (n=14/92; 15%); and Interprofessional Teamwork (n=9/92; 10%).

CONCLUSION

Radiologic clinicians face substantial communicative challenges focused on conveying serious, unexpected and uncertain diagnoses amid practical challenges and limited educational opportunities.

PRACTICE IMPLICATIONS

Innovative educational curricula that address these challenges may enhance radiologic practitioners' success in adopting patient-centered communication.

Teaching Principles of Patient-Centered Care During Radiology Residency

RATIONALE AND OBJECTIVES

Patient-centered healthcare delivery has become increasingly established as a cornerstone of quality medical care, but teaching these principles in a radiology residency setting is often difficult and ineffective in a traditional lecture format. We developed a novel educational session in which actual patient letters about a healthcare provider are used to facilitate a case-based discussion of key principles of patient-centered care.

MATERIALS AND METHODS

A novel patient letter-facilitated, case-based session was conducted at two different university-based teaching institutions. Prior to the educational session, patient letters introducing the principles of patient-centered care were distributed to residents for review. During the session, radiology-specific cases were discussed in the context of the principles introduced by the letters. A post-session survey was administered to evaluate the efficacy and usefulness of the session.

RESULTS

Forty-six of the 61 session attendees (75%) completed the post session survey. Most respondents (93%) preferred this case-based, interactive session to a typical didactic session. A majority of the residents indicated that both the patient letters (64%) and radiology specific cases (73%) helped them think differently about how they interact with patients. They indicated that the session enhanced their understanding of professionalism (3.7 out of 5.0 [95% CI 3.4-4.0]) and increased their motivation to become more patient-centered (3.0 out of 4.0 [95% CI 2.8-3.3]).

CONCLUSIONS

Our findings suggest that patient letter-facilitated, case-based sessions may influence resident attitudes regarding the principles of patient-centered care and may help to increase resident motivation to become more patient-centered in their own practice.

Risk management in radiology departments

Medical imaging and interventional radiology sustained prompt changes in the last few years, mainly as a result of technology breakthroughs, rise in workload, deficit in workforce and globalization. Risk is considered to be the chance or possibility of incurring loss or of a negative event happening that may cause injury to patients or medical practitioners. There are various causes of risks leading to harm and injury in radiology departments, and it is one of the objectives of this paper to scrutinize some of the causes. This will drive to consideration of some of the approaches that are used in managing risks in radiology. This paper aims at investigating risk management in radiology, and this will be achieved through a thorough assessment of the risk control measures that are used in the radiology department. It has been observed that the major focus of risk management in such medical setting is to reduce and eliminate harm and injury to patients through integration of various medical precautions. The field of Radiology is rapidly evolving due to technology advances and the globalization of healthcare. This ongoing development will have a great impact on the level of quality of care and service delivery. Thus, risk management in radiology is essential in protecting the patients, radiologists, and the medical organization in terms of capital and widening of the reputation of the medical organization with the patients.

Should we tell parents when we've made an error?

One of the most difficult experiences for any doctor or nurse is when they realize that they have made a mistake that has harmed a patient. In the past, mistakes were seldom disclosed to patients. The prevailing ethos was one of professional silence, secrecy, and shame. That has begun to change. Many professional organizations in both medicine and health law recommend full disclosure of mistakes and apologies for the harm that is caused. An atmosphere of openness and honesty leads to a culture of quality and safety. In this Ethics Rounds, we analyze the complex emotional and ethical issues that arise when doctors recognize that an error has occurred.

“Apologies” from Pathologists

How pathologists communicate an error is complicated by the absence of a direct physician–patient relationship. Using 2 examples, we elaborate on how other physician colleagues routinely play an intermediary role in our day-to-day transactions and in the communication of a pathologist error to the patient. The concept of a “dual-hybrid” mind-set in the intermediary physician and its role in representing the pathologists’ viewpoint adequately is considered. In a dual-hybrid mind-set, the intermediary physician can align with the patients’ philosophy and like the patient, consider the smallest deviation from norm to be an error. Alternatively, they might embrace the traditional physician philosophy and communicate only those errors that resulted in a clinically inappropriate outcome. Neither may effectively reflect the pathologists’ interests. We propose that pathologists develop strategies to communicate errors that include considerations of meeting with the patients directly. Such interactions promote healing for the patient and are relieving to the well-intentioned pathologist.