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Malpractice issues in radiology (2nd ed.)
BOOK REVIEW
Malpractice Issues in Radiology (2nd ed.) Leonard Berlin, MD, Published by the American Roentgen Ray Society/ 2003/915 pp/$125
Mark D. Hiatt, MD, MS, MBA Can a radiologist be successfully sued by a patient he never saw about a film he never read? Leonard Berlin and his contributors address this topic and many others in the second edition of Malpractice Issues in Radiology. This nearly 1000-page compilation of Dr. Berlin’s prolific writings deals with the medicolegal issues that affect the practice of every radiologist. These excellent articles were previously published in various radiology journals, mostly the American Journal of Roentgenology, which for nearly 8 years carried a column from Dr. Berlin in every issue. Although some of these writings are a couple of decades old, their relevance may be even greater in this era of heightened liability risk and more numerous and complex legal compliance pressures. Indeed, radiologists have in recent years been the targets of attorneys more often than physicians of most other medical specialties. Any radiologist, whether in training or at the end of a long career, could benefit from reading Dr. Berlin’s book. It covers practically every topic that could subject a radiologist to legal action, including errors in diagnosis, the communication of results, and complications of both diagnostic and interventional procedures. The scope and depth of this collection of articles are impressive. As for readability, the book is unexpectedly and refreshingly clear and even entertaining at times. Dr. Berlin engages his readers’ attention by presenting principles in the
context of cases, many of which are accompanied by images. I found myself reading with interest and anticipation to discover the conclusion of each case. What did the jury decide? How did the judge rule? Looking at reproductions of the actual films in question, readers can quiz themselves to see if they would have made the same mistakes. As reported in chapter 59, for example, an emergency room (ER) doctor had an x-ray taken of his own chest because of a cough. He did not register, though, and the study was never officially read by the radiologist on duty. The ER physician looked at the film, but failed to see the small cancer developing in his lung. Seventeen months later, another x-ray was taken, which revealed the enlarged tumor. Before his death, the ER doctor sued the radiologist on duty at the time of the original radiograph for failing to detect the cancer in its early stage. Was this defendant radiologist responsible for a film he never saw of a person who never became a registered patient? What did the jury decide? Would a decision involving $2.9 million surprise you? Readers will find themselves compelled to read on to ascertain the verdict of each case. In doing so, readers will learn a little about the law (without being subjected to boring discussions replete with legalese) and a lot about what can be done to avoid being in the same positions as the unfortunate protagonists of Dr. Berlin’s engaging stories. At the end of most articles,
Dr. Berlin includes a concise discussion of how to minimize one’s risk of incurring a medical malpractice lawsuit and maximize the chance for a successful defense if such a suit is filed. Readers will also find that such actions enhance good patient care. Pertaining to the case of the ER physician who failed to register (as well as failed to find the cancer in his own lung), for example, Dr. Berlin stresses the importance of accurately registering and processing patients who undergo radiologic examinations. He further adds that “juries are prone to suspect that radiologic interpretations that either cannot be found or have never been issued indicate that radiologists may be attempting to cover up information to avoid selfincrimination.” Dr. Berlin’s discussion does become slightly less engaging when he describes and occasionally quotes from the pertinent case law, but his judiciously limited presentation has the advantage of giving readers a taste of legal thinking and terminology in manageable bites. Another potential failing is the absence of an index. Because no index accompanies this voluminous work, readers who use the text as a resource for occasional consultation may find the rapid location of desired information somewhat daunting. However, the subjects are so clearly organized into sections in the table of contents that searching for topics is surprisingly straightforward. Dr. Berlin’s work is undoubtedly an invaluable resource to every radiologist. Residency programs may wish to use this book as a basis for regular discussions on malpractice issues and radiology groups would benefit by having it in their libraries for frequent (but hopefully strictly prophylactic) consultation.
Mark D. Hiatt, MD, MS, MBA, Stanford University Medical Center, Department of Radiology, 300 Pasteur Drive, Stanford, CA 94305-5105; e-mail: [email protected]. © 2004 American College of Radiology 0091-2182/04/$30.00 ● DOI 10.1016/j.jacr.2004.03.009
789
Malpractice Issues in Radiology (2nd ed.) Leonard Berlin, MD, Published by the American Roentgen Ray Society/ 2003/915 pp/$125
Mark D. Hiatt, MD, MS, MBA Can a radiologist be successfully sued by a patient he never saw about a film he never read? Leonard Berlin and his contributors address this topic and many others in the second edition of Malpractice Issues in Radiology. This nearly 1000-page compilation of Dr. Berlin’s prolific writings deals with the medicolegal issues that affect the practice of every radiologist. These excellent articles were previously published in various radiology journals, mostly the American Journal of Roentgenology, which for nearly 8 years carried a column from Dr. Berlin in every issue. Although some of these writings are a couple of decades old, their relevance may be even greater in this era of heightened liability risk and more numerous and complex legal compliance pressures. Indeed, radiologists have in recent years been the targets of attorneys more often than physicians of most other medical specialties. Any radiologist, whether in training or at the end of a long career, could benefit from reading Dr. Berlin’s book. It covers practically every topic that could subject a radiologist to legal action, including errors in diagnosis, the communication of results, and complications of both diagnostic and interventional procedures. The scope and depth of this collection of articles are impressive. As for readability, the book is unexpectedly and refreshingly clear and even entertaining at times. Dr. Berlin engages his readers’ attention by presenting principles in the
context of cases, many of which are accompanied by images. I found myself reading with interest and anticipation to discover the conclusion of each case. What did the jury decide? How did the judge rule? Looking at reproductions of the actual films in question, readers can quiz themselves to see if they would have made the same mistakes. As reported in chapter 59, for example, an emergency room (ER) doctor had an x-ray taken of his own chest because of a cough. He did not register, though, and the study was never officially read by the radiologist on duty. The ER physician looked at the film, but failed to see the small cancer developing in his lung. Seventeen months later, another x-ray was taken, which revealed the enlarged tumor. Before his death, the ER doctor sued the radiologist on duty at the time of the original radiograph for failing to detect the cancer in its early stage. Was this defendant radiologist responsible for a film he never saw of a person who never became a registered patient? What did the jury decide? Would a decision involving $2.9 million surprise you? Readers will find themselves compelled to read on to ascertain the verdict of each case. In doing so, readers will learn a little about the law (without being subjected to boring discussions replete with legalese) and a lot about what can be done to avoid being in the same positions as the unfortunate protagonists of Dr. Berlin’s engaging stories. At the end of most articles,
Dr. Berlin includes a concise discussion of how to minimize one’s risk of incurring a medical malpractice lawsuit and maximize the chance for a successful defense if such a suit is filed. Readers will also find that such actions enhance good patient care. Pertaining to the case of the ER physician who failed to register (as well as failed to find the cancer in his own lung), for example, Dr. Berlin stresses the importance of accurately registering and processing patients who undergo radiologic examinations. He further adds that “juries are prone to suspect that radiologic interpretations that either cannot be found or have never been issued indicate that radiologists may be attempting to cover up information to avoid selfincrimination.” Dr. Berlin’s discussion does become slightly less engaging when he describes and occasionally quotes from the pertinent case law, but his judiciously limited presentation has the advantage of giving readers a taste of legal thinking and terminology in manageable bites. Another potential failing is the absence of an index. Because no index accompanies this voluminous work, readers who use the text as a resource for occasional consultation may find the rapid location of desired information somewhat daunting. However, the subjects are so clearly organized into sections in the table of contents that searching for topics is surprisingly straightforward. Dr. Berlin’s work is undoubtedly an invaluable resource to every radiologist. Residency programs may wish to use this book as a basis for regular discussions on malpractice issues and radiology groups would benefit by having it in their libraries for frequent (but hopefully strictly prophylactic) consultation.
Mark D. Hiatt, MD, MS, MBA, Stanford University Medical Center, Department of Radiology, 300 Pasteur Drive, Stanford, CA 94305-5105; e-mail: [email protected]. © 2004 American College of Radiology 0091-2182/04/$30.00 ● DOI 10.1016/j.jacr.2004.03.009
789