Cal Burton backed his red Porsche Carrera 911 cabriolette near a pine tree in front of the Armstrongs’ to prevent a bump or scratch from a drunk or careless partier. He strolled through the front door without a knock, looking for John. Cal was always impeccably dressed, and today he was dapper in his polo shirt and pressed pants. He arrived just in time to catch the end of Rick’s diatribe.

“Then who would attend these wonderful parties?” Cal said. He smiled as he reached up and placed his hand on his host John Armstrong’s shoulder. John noticed that Cal’s short brown hair now had grey streaks in it. Had that many years passed?

“Rick, meet Cal Burton. Trial lawyer and medical malpractice expert. No one is better.”

Rick gave Cal an embarrassed smile. “I sort of got carried away there. I hope I didn’t offend you.”

Cal smiled back as only a practiced litigation attorney can. Rick could have cursed Cal’s mother and he would have just grinned. The party was a prime source for his referrals and leads, and he was not going to let a half-drunk redneck radiologist screw it up. “No offense taken. I understand your anger. There’s plenty of resentment between malpractice attorneys and doctors. One thing you have to understand is that we are the only watch-dog there is. Doctors have never policed themselves well enough to prevent bad doctors from practicing. Only bad doctors and people with bad judgment ever have legal problems. Wouldn’t you agree, John?”

John smiled. “Don’t look at me to make your case, counselor.” John moved away and made himself another drink. “Can I get you one, Cal? Or are you working?”

Cal waved Armstrong off with his hand. “Anyway, look at our former President; taken down not by a psychotic younger lover, but by his own bad judgment. Taken another way, by his own air of invincibility. When men start to believe they are above the law, they will inevitably make a mistake and are doomed to failure.”

“Clinton was trying to be like Kennedy, but Monica was no Monroe,” Rick said. “As for malpractice, I only half agree with you. I agree we don’t police ourselves well, but part of that is the government’s fault. They allow bad doctors from every third world country to train here, then stay. If we could keep out these bad foreign doctors, we would be okay.

“You think? Most of the work I get is from regular doctors like yourself. Not foreigners.”

John stepped in smoothly. “Cal is working on an interesting case now where I’m an expert witness. Maybe it’s something you could do in the future.”

Cal’s smile eased the tension. “Yeah. John loves it and thinks it’s very interesting because he gets three hundred dollars an hour!”

John glanced at Cal, anger still in his eyes.

“Oops, I guess I was not supposed to tell you that. Pretend you didn’t hear that from me.”

John managed a smile. “Cal, you’re a real classy guy.”

“I don’t think I could do it,” Rick said. “I would feel like a traitor.”

“Rick, you could work for the defense, helping the doctor defend him or herself. You don’t have to be an expert witness for the plaintiff.” Cal said.

There was a long, awkward pause. “Well, enough shop talk. Let’s get some food.” John led them out into the yard.

Excerpted from LOCKED IN by Mike Esposito. Copyright © 2007 by Mike Esposito. All rights reserved. Excerpted by permission of the publisher. www.mikeespositomd.com

Author

Growing up in NYC, Mike Esposito never imagined that he would end up in Florida. After graduating high school on Staten Island, he attended the University of Florida and then went on to medical school at University of South Florida in Tampa.

After his radiology residency in Tampa he finished up his training in fellowship at Duke University. Soon after he took up a job as a radiologist in a Tampa area practice.

“My career in radiology has been rewarding but I needed a new challenge. Writing provided me an outlet but soon became an obsession and a second job. The end was LOCKED IN, my first completed full-length novel. I hope you enjoy it.” - Mike Esposito

For more information, please visit www.mikeespositomd.com

The following is an excerpt from the book What You Don’t Know Can Kill You
by Dr. Laura Nathanson
Published by Collins; May 2007;$15.95US/$19.95CAN; 978-0-06-114582-7
Copyright © 2007 Laura Nathanson

Red Flags in Radiology Reports:
An Added Crucial Step

The only radiologist who double-checks a radiology report is the radiologist who wrote it. There is nobody in charge of reviewing reports for completeness, much less for accuracy and clarity of expression. One exception: there are institutions that have installed special software with templates that require the radiologist to fill in every item recommended by the guidelines of the American College of Radiology. If one stays blank, the report can’t be signed out or billed for.

But, you might say, the clinical physician who ordered the report and receives the interpretation must review it for clarity and completeness. Right? Isn’t there a double-check on the report?

Alas, nobody checks that the clinical physician actually does read the report. Every time there is a communication between doctor and doctor, about anything, there is a new opportunity for error. So you, Vigilant One, need to keep a special eye on data reports of all kinds, including radiology reports. Here’s how:

First, once again, you preshrink the report:

* Substitute every medical jargon word with “thing,” “thingy,” etc.
* Search for scary words and uncertain terms.
* See if there is a scary diagnosis that has not been excluded.
* Look for any signs of fuzzy logic.

Then — and this is new — you go on to an additional set of red flags reserved for data reports.

First, the clinical physician has ordered a study to answer a specific question: What’s that metallic thing up the kid’s nose? Is this wrist fractured? Does this woman have pneumonia? A red flag is indicated by a report’s failure to include any of the following:

* The data doctor must make clear that he understands the question — the reason for the test.
* The data doctor must describe his findings clearly enough so that the clinical physician can judge the reasonableness of the data doctor’s diagnosis.
* The data doctor also ought to give either a specific diagnosis (”Mason lapel pin high in left nostril”) or a differential diagnosis (”Foreign body, metallic, high in left nostril? Barbie slipper charm? earring? part of dog collar?”)
* Finally, if the data doctor feels it is appropriate, he should suggest further study or action. (”Recommend prompt removal of foreign body in nose due to danger of aspiration during sniffing.”)

The clinical physician and data doctor should be engaged in an active written dialogue where each listens to and queries the other with attention and respect. This means that the clinical physician should review each data report critically to make sure that the most important question has been understood and answered.

The second step in checking a data report is to make sure that its import actually got through to the clinical physician. If a serious error or omission in such a report goes unnoticed by the clinical physician, there can be dire results.
(more…)