The Radiology Fellow – Avoidable Medical Malpractice Case

The Radiology Fellow – Avoidable Medical Malpractice Case


Patricia Buckley was a retired teacher who
lived most of her life in the midwest, but had recently moved to Dayton, Ohio. She shared
a small 1-bedroom apartment with her trusted companion of many years – a parrot named Mr.
Gatsby. Most nights she would watch movies, but occasionally she enjoyed hosting small
dinner parties. One morning, as Patricia was cleaning her house, she suddenly felt tired
and dizzy, and as the day progressed, she felt more achy and developed a slight cough.
“I hope I’m not getting sick right before my trip to Europe,” she thought aloud, as
she picked up the phone to make an appointment with her primary care physician. The next day, Patricia arrived for her appointment
with her primary physician, Dr. Larson. The conversation was relaxed. Patricia said she
was mostly worried about the fatigue. She explained, “I’m going to visit my daughter
and my lovely grandson in Europe for the summer, and I’m pretty sure I won’t be able to keep
up with him or help around the house if I’m exhausted like this.” Dr. Larson explained
that she thought it was most likely a viral infection, but that she needed to get some
blood tests and a chest X-ray just in case Patricia had developed a walking pneumonia
or something called parrot fever – both of which could be treated with antibiotics. Patricia
felt reassured and headed out to get the lab work and chest X-ray done. A few hours later, an overnight radiology
fellow, Dr. Samir Patel, was reading the chest X-ray of patient 7322881. He didn’t know
Patricia – he just knew her medical record number. The reason for the chest X-ray? Two
words “rule-out pneumonia”. He squinted at the image and sipped his Chamomile tea.
No signs of pneumonia, but he noticed a small oval shape on her left upper lobe. “Could
this be a tumor? Or tuberculosis?”, he wondered as dictated the report. “Findings: No evidence
of pneumonia. 1-centimeter oval lesion in the left upper lobe. No hilar adenopathy…“
he finished up. He clicked over to review the next case. A few hours later he called
it a night. The next morning Dr. Patel reviewed the radiographs
from the previous night with his attending. The attending agreed – there wasn’t any
evidence of pneumonia, but that oval shape was unusual and definitely needed following
up on. Dr. Patel wrote down the patient’s phone number on a pad of paper. Dr. Patel batched all of his follow up calls
and did them each Friday. That Friday, when he called Patricia nobody answered and he
left a voicemail. A week later he called again, and left another voicemail. Two weeks later
the voicemail inbox was full and wasn’t accepting any more messages. Dr. Patel struck
the number off his list – by that point, he could barely remember what the call was even
about. What Dr. Patel didn’t know was that Patricia
was in Switzerland and wasn’t getting her voicemails. Near the end of the summer, Patricia’s
health rapidly declined so she flew back to the US to stay with extended family. A few
weeks later, Patricia passed away due to metastatic lung cancer. One afternoon, Dr. Patel received a letter
stating that his hospital was being sued and that he was named in the lawsuit because he
had done the initial dictation on the chest X-ray. Now – to rewind this back – let’s imagine
that Dr. Patel or someone on his team had gotten in contact with Patricia’s primary
physician, Dr. Larson. Dr. Larson had a more established relationship with Patricia and
may been able to contact her while she was in Europe. It’s possible that Patricia could
have had further studies done to work up this lung nodule – perhaps a CT or MRI. An earlier
diagnosis might have given her a better shot at chemotherapy, and perhaps she wouldn’t
have died. The moral? Share incidental findings and other clinical information with the primary
care physician as well as the patient.

Daniel Yohans

21 thoughts on “The Radiology Fellow – Avoidable Medical Malpractice Case

  1. Carbamazepine Rx says:

    first comment 😂😘

  2. Al Arzu says:

    Passed away,

  3. Abdl says:

    I keep tuning in by 10pm everyday for a 'shot' of this series

  4. MrThomas says:

    Wtf. The physician gets the results also. Nodular opacity… you call the patient. The physician is the manager of the case, she should've called the patient and inform her. As a radiologist resident myself I think this is bs. Our job is hard enough already, making phone calls is not part of it. If the physician doesn't understand something then they will call you to discuss the case.

  5. Dr_B ! says:

    This is BS. Haba he tried his very best, even reviewed the X-ray with the attending.

  6. Emiliano Moreno says:

    This series is seriously making me reconsider my career.

  7. padelackles says:

    Whoever orders the test is primarily responsible for follow up. And suing because someone repeatedly tried and failed to contact you is one of the many, many issues with "malpractice" suits

  8. IraTheSquire says:

    This one is particularly weird. I thought that the radiologist would report back to the person (usually the GP or the treating team) ordering the imaging, not directly talking to the patient (who probably wouldn't even know the radiologist).

    Is there any links to the actual case? I don't know how it works in the US but in Queensland (cue: Australia) you can at least get the decisions made by the courts.

  9. rap c says:

    It's not the radiologist's fault. He stated at the report a nodular lesion was found. It is the duty of the physician who ordered the CXR to follow up the patient regarding the findings

  10. jbrowsingj says:

    on which case is this based on? it seems counter to actual clinical practice.

  11. Random Person says:

    What I don't understand is, how did the woman leave the country without finding out the results of her tests? The whole reason for the tests were to see IF she can go to Europe or not.

  12. TheImpiroGirl says:

    Once again I would like to hear the outcome of the lawsuit in question, this seems a little out there…

  13. Abdl says:

    This is definitelyan unfair one! He did his job and that was to report the xray! He has no business getting in touch with the patient! He'd probably won the lawsuit!

  14. Kyle VanDePerre says:

    Okay, this is an avoidable lawsuit. As in, it shouldn’t be happening. A copy of the dictated and transcribed report is always sent to the ordering physician, and it is their responsibility to follow up with the patient. The fact that this radiologist tried personally for a few weeks to contact the patient is almost unheard of! If a radiologist made this attempt for every incidental finding, they would never have time to read any X-rays!

  15. tulip 3650 says:

    I just don't why its the radiologist fault. His job is to report the xray thats it. The rest is upto the physician.. this is really sad.

  16. folumb says:

    If radiologists had to call every patient and do this, I cannot imagine how anything would get read. I'm enjoying the lessons of this series, but this vignette is just bad. Can any radiology resident, fellow or attending speak to the likelihood of this kind of suit being brought (let alone successful)?

  17. oawefajweee says:

    It doesn't add up. Sounds like there's a missing piece to this case.

  18. mdmit says:

    All of this is utter nonsense.

  19. edvard says:

    what is this shit ma'am, i'm studying medicine not the law.

  20. The Elo Surgeon says:

    are you guys high? the radiologist reports to the physician, not the patient. the entire reason the doctor ordered the tests were to rule out pneumonia or psittacosis. how the hell could "Patricia" fly to europe without knowing the results?

    so if "patricia" was in the eu that means the doctor had the results of the xray (INCLUDING IMAGES OF THE FILM TO REVIEW HERSELF) and let "patricia" go to eu anyways. thats gross negligence on the docs part, not the radiologist.

    the radiologist will have indicated in his impression to followup on the abnormality because it may be cancer. this video is full of holes, as were a few other ones youve been doing. ffs.

  21. whatthewhat11 says:

    The GP must have been listed in this lawsuit as well. Ultimately it is the ordering physician's responsibility to follow-up on all diagnostic testing they order. Also, I find it hard to believe that if the rad reached out directly to the pt multiple times, that they didn't notify the GP as well.

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