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When Reporting Adverse Events, Less = More
LETTERS TO THE EDITOR
When Reporting Adverse Events, Less ¼ More In the September 2015 JACR “Speaking of Language” column, titled “Inadvertent s Accidental,” Dr Samson Munn urges radiologists to use the word unintended, accidental, or unintentional instead of inadvertent when reporting adverse events because, as he argues, inadvertent implies carelessness, while the other terms do not connote fault [1]. I have a better suggestion. When describing adverse events, do just that, without adjectives or adverbs of any kind. Consider: Dr Munn would say, “During balloon angioplasty the arterial wall was accidentally perforated” (instead of “inadvertently perforated”). One should say, “During balloon angioplasty the arterial wall was perforated.” First, the word accidental, no matter how nuanced the interpretation, invites suspicion that the standard of care was violated. Second, words such as accidental and unintended are superfluous in this context unless there are instances of balloon angioplasty in which the vessel wall is intentionally perforated, which in fact is never the case. Moreover, adverse events in medical practice are never intentional unless the operator means the patient harm, which, one would hope, is never the case. Any adverse event is, ipso facto, unintentional. The message from the column should not be that accidental, unintended, or unintentional is preferable to inadvertent but that such words have no place in the radiology lexicon.
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Robert Feld, MD St Francis Hospital and Medical Center Interventional Radiology 114 Woodland Street Hartford, CT 06115 e-mail: [email protected] The author has no conflicts of interest related to the material discussed in this article.
REFERENCE 1. Munn S. Inadvertent s accidental. J Am Coll Radiol 2015;12:897. http://dx.doi.org/10.1016/j.jacr.2015.10.016 S1546-1440(15)01082-0
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Author’s Reply I thank Dr Feld for his thoughtful comments! I agree that an adverse event is always unintended in proper practice. Also, I am likewise attracted to streamlined reports. Fewer words often means fewer opportunities for misinterpretation of their meanings, and shorter reports are more likely to be read in their entireties. The original article was about the word inadvertent. The purpose was not to advocate that a neutral descriptor necessarily be added to the record in the setting of an untoward event but rather that if one is inclined to use inadvertent, don’t! That was why the article ended “to avoid the confusing connotation of fault” with regard to inadvertent. An adverse event may have a number of ramifications for the provider. There may be a patient complaint to the hospital, to a state medical board, or to The Joint Commission; an internal hospital investigation (such as a root-cause analysis); civil litigation; or even criminal charges. It is strongly recommended
that defensive commentary not be placed in the medical record. Even worse is defensive commentary recorded after substantial time delay. On the other hand, placement of a neutral, clarifying, and descriptive word or phrase in the record provides lucidity for anyone assessing the event. Examples of such words are unintended and unintentional. The contemporaneous element adds credibility, logically and legally. Reviewers, juries, and others understand that accidents can happen. They don’t automatically place accidental adverse events in the category of negligence. Because Dr Feld believes that accidental “invites suspicion” (although I do not entirely agree), he is free to consider no adjective (as he advocates) or a neutral, clarifying word or phrase placed contemporaneously. True, adding a nondefensive word or two makes the report a tiny bit longer. The subsequent benefit may sometimes far outweigh that minimal detraction. Samson Munn, MD Tufts Medical Center Department of Radiology 800 Washington Street, #299 Boston, MA 02111-1552 e-mail: [email protected] The author has no conflicts of interest related to the material discussed in this article. http://dx.doi.org/10.1016/j.jacr.2015.11.005 S1546-1440(15)01220-X
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Leveraging Imperfect Data Sets to Draw New Conclusions: Radiogenomics’ True Value? We read with great interest the recent report by Dr Mazurowski [1]
1546-1440/15/$36.00
n
ª 2016 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2015.10.016
When Reporting Adverse Events, Less ¼ More In the September 2015 JACR “Speaking of Language” column, titled “Inadvertent s Accidental,” Dr Samson Munn urges radiologists to use the word unintended, accidental, or unintentional instead of inadvertent when reporting adverse events because, as he argues, inadvertent implies carelessness, while the other terms do not connote fault [1]. I have a better suggestion. When describing adverse events, do just that, without adjectives or adverbs of any kind. Consider: Dr Munn would say, “During balloon angioplasty the arterial wall was accidentally perforated” (instead of “inadvertently perforated”). One should say, “During balloon angioplasty the arterial wall was perforated.” First, the word accidental, no matter how nuanced the interpretation, invites suspicion that the standard of care was violated. Second, words such as accidental and unintended are superfluous in this context unless there are instances of balloon angioplasty in which the vessel wall is intentionally perforated, which in fact is never the case. Moreover, adverse events in medical practice are never intentional unless the operator means the patient harm, which, one would hope, is never the case. Any adverse event is, ipso facto, unintentional. The message from the column should not be that accidental, unintended, or unintentional is preferable to inadvertent but that such words have no place in the radiology lexicon.
120
Robert Feld, MD St Francis Hospital and Medical Center Interventional Radiology 114 Woodland Street Hartford, CT 06115 e-mail: [email protected] The author has no conflicts of interest related to the material discussed in this article.
REFERENCE 1. Munn S. Inadvertent s accidental. J Am Coll Radiol 2015;12:897. http://dx.doi.org/10.1016/j.jacr.2015.10.016 S1546-1440(15)01082-0
n
Author’s Reply I thank Dr Feld for his thoughtful comments! I agree that an adverse event is always unintended in proper practice. Also, I am likewise attracted to streamlined reports. Fewer words often means fewer opportunities for misinterpretation of their meanings, and shorter reports are more likely to be read in their entireties. The original article was about the word inadvertent. The purpose was not to advocate that a neutral descriptor necessarily be added to the record in the setting of an untoward event but rather that if one is inclined to use inadvertent, don’t! That was why the article ended “to avoid the confusing connotation of fault” with regard to inadvertent. An adverse event may have a number of ramifications for the provider. There may be a patient complaint to the hospital, to a state medical board, or to The Joint Commission; an internal hospital investigation (such as a root-cause analysis); civil litigation; or even criminal charges. It is strongly recommended
that defensive commentary not be placed in the medical record. Even worse is defensive commentary recorded after substantial time delay. On the other hand, placement of a neutral, clarifying, and descriptive word or phrase in the record provides lucidity for anyone assessing the event. Examples of such words are unintended and unintentional. The contemporaneous element adds credibility, logically and legally. Reviewers, juries, and others understand that accidents can happen. They don’t automatically place accidental adverse events in the category of negligence. Because Dr Feld believes that accidental “invites suspicion” (although I do not entirely agree), he is free to consider no adjective (as he advocates) or a neutral, clarifying word or phrase placed contemporaneously. True, adding a nondefensive word or two makes the report a tiny bit longer. The subsequent benefit may sometimes far outweigh that minimal detraction. Samson Munn, MD Tufts Medical Center Department of Radiology 800 Washington Street, #299 Boston, MA 02111-1552 e-mail: [email protected] The author has no conflicts of interest related to the material discussed in this article. http://dx.doi.org/10.1016/j.jacr.2015.11.005 S1546-1440(15)01220-X
n
Leveraging Imperfect Data Sets to Draw New Conclusions: Radiogenomics’ True Value? We read with great interest the recent report by Dr Mazurowski [1]
1546-1440/15/$36.00
n
ª 2016 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2015.10.016