Law and Medicine Vol 1.1

By Dainius A. Drukteinis, M.D., J.D.

“The only real mistake is the one from which we learn nothing.”
- John Powell


Radiology Hearsay in the Emergency Department

How often have you spoken with radiology on the phone before an official report has been dictated?

An emergency medicine physician in Louisiana recently found his understanding of radiology findings at odds with the dictated radiology report. See Spillman v. Southwest Louisiana Hospital Association, 2007 U.S. Dist. LEXIS 25547 (April 4, 2007).

In Spillman, a child was brought to an emergency department and a CT scan was obtained to rule out appendicitis. Radiology called an emergency department nurse with the result. The nurse then relayed the result to the attending physician

…appendix area looks o.k., no mass or inflammation noted.

Once the patient was discharged, radiology dictated a report which stated,
…possible fluid-filled dilated appendix seen in the right lower abdomen.  The possibility of appendicitis cannot be excluded or confirmed.

It was later determined that the child had a ruptured appendix.

Whether or not you believe the radiologist changed the findings, this miscommunication could have been further compounded had the nurse told a resident, who then told the attending, who then signed out the patient to the oncoming team.

The scenario quickly begins to look like the childhood game of telephone. It is for this reason that courts frown upon hearsay evidence, and that written communication tends to be given more weight than oral communication. That is not to say we should never rely on oral communications by radiology or other services in the hospital. However, we must be wary that in our desperate need to disposition patients quickly, there are many ways that essential communication can break down and harm our patients.

This case was ultimately decided in favor of the doctor on different grounds.

Dainius A. Drukteinis, M.D., J.D. is an Attending Physician at MetroWest Medical Center in Framingham, Massachusettes. He may be contacted at ddrukteinis@gmail.com

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