A photograph captures a moment in time. We most often take photos of happy occasions or of scenes and objects that fascinate or inspire us in our day-to-day lives.
Photos and imaging are also used to preserve memories of less positive aspects of life: photojournalism may record natural disasters and conflicts; police often rely on crime scene photos.
Photos can also be used for medical and diagnosis purposes. Medical imaging can provide evidence of abnormalities and malignant tumours that may not turn up through other diagnostic tests.
Advances in radiology have been hugely beneficial to doctors and their patients in recent years. Being alerted to a potential problem on a scan early enough can make a significant difference in patient outcomes. That being said, if an image is misinterpreted and, as a result, the patient is misdiagnosed by their doctor, it can lead to unnecessary pain, disability, shortened life expectancy or even death.
In this blog post, I will explain how medical negligence actions can result from can cause or contribute to misinterpretation and/or misdiagnosis of radiology imaging and what you can do if you believe you or a loved one has been a victim of medical malpractice.
Where Is the Line Between Human Error and Negligence?
Since x-ray technology was first discovered and used for diagnostic purposes at the end of the 19th century, radiological imaging has advanced in many ways. Computed Tomography, magnetic resonance imaging and ultrasound images have expanded what medical professionals can see in soft tissue structures, internal organs and particularly sensitive parts of the body such as the brain.
As these scans are refined, radiologists must continually update and refresh their technical skills to ensure they can use these detailed pictures to the full extent possible. However, human error is still possible.
Research indicates that between three to five per cent of interpretations by radiologists in their daily practice contain errors.1 Most of these errors are minor and do not substantially affect patient outcomes. However, studies that looked at the "retrospective miss rate" (where patient scans are reviewed at a later date) found as many as 30 per cent of these scans contained significant pathologic findings that were not identified. In retrospective cases of patients who developed lung or breast carcinomas (cancers), reviews of scans found evidence of these pathologies in 90 and 75 per cent of cases, respectively.2
What Is the Standard of Care for Radiologists?
Missing pathology on medical imaging is not always malpractice. If pathology is missed and would have been seen by the average practitioner, it may be negligence. On the other hand, if pathology is very difficult to see or interpret, it is unlikely that negligence will be found.
Professional organizations such as the Canadian Association of Radiologists (CAR) establish practice principles and guidelines for standards of care. However, specific patient situations or the availability of resources may call for deviation from these guides.
Ultimately, to meet the standard of care, a radiologist must act in a way that another reasonably prudent radiologist with equivalent experience, training and resources would have acted or been expected to act. Sub-specialists are held to a higher standard than non-specialists, and technicians in teaching hospitals or clinics are held to a higher standard than their colleagues at smaller regional hospitals or clinics.
How Do We Know When Standards of Care Are Breached?
Medical malpractice cases can often be difficult to litigate because all the best evidence may not be available. If errors or delays occur due to negligence during treatment or diagnosis, determining why a person acted in a certain way or what information was available to them at the time may be dependent on hazy recollections or notes that may not give a fulsome explanation of what happened.
If radiology scans were taken, however, we can get a very clear picture in time to anchor a case. For example, in medical malpractice cases where I have had access to radiological imaging, I have sought out experts or radiologists of equivalent standing to review them blindly (without the context of the case or ultimate diagnosis). If they spot an abnormality without knowing what they ought to be looking for, they can tell me if it would have been something that would have clearly called for additional investigation, a timely follow-up, or action on the part of a treating physician.
It's said that a picture never lies. While we may reasonably come to a difference of opinion or interpretation of what we see in a picture, it is very difficult to argue that something clearly visible is not there.
Photographic evidence such as radiology scans - particularly multiple scans completed over a period of time - can be crucial in establishing that negligence caused or contributed to a medical error.
What Should You Know as a Patient?
One of the most frustrating things a patient experiencing pain, deteriorating health, or an unfavourable prognosis can learn is that something more could have been done if only a treating physician had come to a correct diagnosis earlier. Sometimes nothing could have been reasonably done differently, but occasionally medical negligence may be to blame.
A few examples: your family doctor or a treating physician receives a radiologist's report and uses the radiologist's interpretation of the image to decide further action or treatment options. If an error in the report leads to a doctor's misdiagnosis, the radiologist would likely be deemed responsible. If the radiologist's report recommended further testing or follow-up and the doctor ignored this information, the doctor's inaction would be questioned.
But for a patient, determining which medical professional is responsible for the error is much less important than correcting the error as soon as possible.
As a patient, if you are advised to return for further testing, be sure to follow up promptly. If your doctor reports that a radiology scan has turned up nothing out of the ordinary, but your symptoms continue, worsen, or your gut tells you that something is just not right, you are entitled to a second or third opinion.
Footnotes
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
