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.
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