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Radiology

The usual system for providing radiology services in a hospital is a contract between the hospital and an individual physician or a practice group. The group agrees to supervise technical personnel and to read and interpret all tests. The hospital gives the group an exclusive contract to provide these services and requires that all tests done in the hospital be done through the group. Patients eventually receive a bill from the radiology group.

One source of liability for radiologists is improper supervision of nonphysician technical personnel and equipment. Physicians are responsible for ensuring that the personnel are adequately trained and doing their jobs properly. Patients must be protected from falls and other simple injuries. The radiologists must ensure that all equipment is functioning, that the tests are technically adequate, and that patients are not exposed to excessive doses of radiation.

Radiologists must carry out special tests and procedures safely and accurately. Whenever there are special procedures, the radiologist should review the patient's history, do a physical examination as necessary to verify critical information, and obtain informed consent for the procedure. For example, if the attending physician has ordered an IVP and the patient is dehydrated, the radiologist has a duty to cancel or postpone the test until the patient is able to tolerate it. If the IVP was done by a technician without the radiologist's evaluating the patient, the radiologist is responsible, not the attending physician. The attending physician could argue that determining the patient's fitness for the test at the scheduled time is the radiologist's responsibility.

Radiologists should interpret tests as completely as possible. There is an unfortunate tendency to equivocate on reports as a way of avoiding responsibility. Giving a report of "possible pneumonitis" instead of "right lower lobe infiltrates consistent with bacterial pneumonia" does not provide the attending physician with the benefit of the expert opinion that a radiologist is expected to provide. Vague readings increase the consultant's liability when they mask serious conditions or substitute for an in-depth review of the film.

Radiologists have a duty to make sure attending physicians are informed quickly of any serious or life-threatening conditions found on a test. Technicians should routinely inform their supervising radiologists about any serious results or results that are strange or unusual. Radiologists also must ensure that the patient is informed of test results and their significance. Usually this is done by alerting the attending physician, who in turn informs the patient and recommends any necessary care. This discharges the radiologist's duty to inform the patient personally.

Problems arise when the attending physician does not inform the patient of the test results. In this case, the radiologist's duty is not discharged, and the patient will have a cause of action against the radiologist for delayed or missed diagnosis. In almost all cases, this failure to inform the patient is due to a failure in the reporting system; the radiology report does not reach the physician's office, or it is filed without being seen by the attending physician. Radiologists must have a system for following up serious findings to ensure that they have been received by the attending physician and transmitted to the patient. Radiologists and other physicians who provide information to attending physicians rather than patients may contract for indemnification if the attending fails to transmit the test results and recommendations to the patient. This does not affect the patient's right to sue the radiologist but will shift the burden of paying the award to the attending physician. More important, it clarifies the duty of the attending to pass on the information to the patient.


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