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Perspectives from the other side of the screen: how clinicians and radiologists communicate about diagnostic errors

  • Anna Lama , Jeffery Hogg and Andrew P.J. Olson EMAIL logo
Published/Copyright: August 15, 2019
Diagnosis
From the journal Diagnosis Volume 7 Issue 1

Abstract

Background

Miscommunication amongst providers is a major factor contributing to diagnostic errors. There is a need to explore the current state of communications between clinicians and diagnostic radiologists. We compare and contrast the perceptions, experiences, and other factors that influence communication behaviors about diagnostic errors between clinicians and radiologists.

Methods

A survey with questions addressing (1) communication around diagnostic error, (2) types of feedback observed, (3) the manner by which the feedback is reported, and (4) length of time between the discovery of the diagnostic error and disclosing it was created and distributed through two large academic health centers and through listservs of professional societies of radiologists and clinicians.

Results

A total of 240 individuals responded, of whom 58% were clinicians and 42% diagnostic radiologists. Both groups of providers frequently discover diagnostic errors, although radiologists encounter them more frequently. From the qualitative analysis, feedback around diagnostic error included (1) timeliness of error, (2) specificity in description or terminology, (3) collegial in delivery, and (4) of educational value through means such as quality improvement.

Conclusions

Clinicians and radiologists discover diagnostic errors surrounding the interpretation of radiology images, although radiologists discover them more frequently. There is significant opportunity for improvement in education and practice regarding how radiologists and clinicians communicate as a team and, importantly, how feedback is given when an error is discovered. Educators and clinical leaders should consider designing, implementing, and evaluating strategies for improvement.

Keywords: diagnostic error; feedback; radiology
Corresponding author: Andrew P.J. Olson, MD, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA; and Department of Pediatrics, University of Minnesota Medical School, 420 Delaware St SE, MMC 741, Minneapolis, MN 55455, USA

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Appendix

 

Diagnostic Error Communication Survey

Please complete the survey below.

Thank you!

Thank you for participating in this survey. All responses will be analyzed anonymously. Please answer ALL the questions below. Thank you!

An information sheet for research is attached here for your reference.

[Attachment: “Information sheet for research v2.pdf”]
Please select which of the following best describes your medical role:○Diagnostic Radiologist or Radiologist in Training
○Practicing clinician or trainee who orders imaging tests
How often do you discover a diagnostic error (that is, an opportunity existed earlier to make a diagnosis) during your work interpreting radiology images?○Daily
○Weekly
○A few times per month
○Every few months
○A few times per year
○Never
How often do you discover a diagnostic error (that is, an opportunity existed earlier to make a diagnosis) when reviewing interpretations of imaging you have ordered?○Daily
○Weekly
○A few times per month tests
○Every few months
○A few times per year
○Never
Have you seen modeling of effective feedback communication about diagnostic error between referring providers and diagnostic radiologists in which the referring doctor has been the “maker” of the error, and the diagnostic radiologist has been the “discoverer” of the error?○Yes
○No
Who has modeled this effective communication?○Peer
○Supervisor
○Trainee
○Other, specify below
Describe your response here:——————————
What about this/these communication(s) made it memorable as “effective”? (Select all that apply)□Specific
□Timely
□Educational
□Collegial
□Face-to-face
□Via Phone
□Via electronic communication
□Other, indicate below
Describe your response here:——————————
Have you seen modeling of effective feedback communication about diagnostic error between referring providers and diagnostic radiologists in which the diagnostic radiologist has been the “maker” of the error, and the referring doctor has been the “discoverer” of the error?○Yes
○No
Who has modeled this effective communication?○Peer
○Supervisor
○Trainee
○Other, specify below
Describe your response here:——————————
What about this/these communication(s) made it memorable as “effective”? (Select all that apply)□Specific
□Timely
□Educational
□Collegial
□Face-to-face
□Via Phone
□Via electronic communication
□Other, indicate below
Describe your response here:——————————
Have you seen modeling of ineffective feedback communication about diagnostic error between referring doctors and diagnostic radiologists in which the referring doctor has been the “maker” of the error, and the diagnostic radiologist has been the “discoverer” of the error?○Yes
○No
If yes, who has modeled this ineffective communication?○Peer
○Supervisor
○Trainee
○Other, specify below:
Describe your response here:——————————
What about this/these communication(s) made it memorable as “ineffective”? (Select all that apply)□Blaming
□Emotional
□Public
□Via phone
□Via electronic communication
□Face to face
□Long time between discovery and disclosure
□Demeaning
□Other, specify below:
Describe your response here:——————————
Have you encountered ineffective feedback communication about diagnostic error between referring doctors and diagnostic radiologists in which the diagnostic radiologist has been the “maker” of the error, and the referring doctor has been the “discoverer” of the error?○Yes
○No
If yes, who has modeled this ineffective communication?○Peer
○Supervisor
○Trainee
○Other, specify below:
Describe your response here:——————————
What about this/these communication(s) made it memorable as “ineffective”? (Select all that apply)□Blaming
□Emotional
□Public
□Via phone
□Via electronic communication
□Face to face
□Long time between discovery and disclosure
□Demeaning
□Other, specify below:
Describe your response here:——————————
To what degree do you feel inhibited to communicate your discovery of a diagnostic error to your colleagues in the referring provider-diagnostic radiologist duo?○Not at all inhibited. I always disclose and discuss errors I discover
○Somewhat inhibited. I try to disclose and discuss errors I discover, but sometimes encounter personal barriers to doing so
○Very inhibited. I rarely disclose and discuss errors
What types of diagnostic error are you likely to actively disclose to referring providers? (Select all that apply)□A diagnosis that could have been made if the proper test had been obtained
□A diagnosis that could have been made if proper follow-up had been performed as recommended in previous studies
□A diagnosis that could have been made if the differential diagnosis in the radiology report had been considered
□Other, please specify
Describe your response here:——————————
How do you usually communicate your discovery of a diagnostic error to your colleagues in the referring provider-diagnostic radiologist duo?□Convey information about the diagnosis in the report without mentioning the error
□Contacting the referring provider personally
□Incident reporting system
How often do you discuss a case IN PERSON with both radiologists and clinicians present?○Daily
○Weekly
○A few times per month
○Every few months
○Once a year
○Never
Please select your specialty○Diagnostic Radiology
○Internal Medicine
○Pediatrics
○Internal Medicine – Pediatrics
○Family Medicine
○Surgery
○Emergency Medicine
○Other, specify:
Describe your response here:——————————
Please select your level of training/practice:○Medical Student
○Intern
○Resident
○Chief Resident
○Junior Faculty (<5 years after training)
○Mid-career Faculty (6–10 years after training)
○Senior Faculty (>10 years after training)

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Received: 2019-06-18
Accepted: 2019-07-21
Published Online: 2019-08-15
Published in Print: 2020-01-28

©2020 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Learning and teaching aren’t the same – the need for diagnosis curricula in graduate medical education
  4. Mini Review
  5. Controversies in diagnosis: contemporary debates in the diagnostic safety literature
  6. Opinion Paper
  7. Balancing confidence and humility in the diagnostic process
  8. Point/Counterpoints
  9. Roots of the total testing process
  10. Total testing process: roots and state-of-the-art
  11. Original Articles
  12. Embedding a longitudinal diagnostic reasoning curriculum in a residency program using a bolus/booster approach
  13. Structured case reviews for organizational learning about diagnostic vulnerabilities: initial experiences from two medical centers
  14. Breakdowns in the initial patient-provider encounter are a frequent source of diagnostic error among ischemic stroke cases included in a large medical malpractice claims database
  15. Perspectives from the other side of the screen: how clinicians and radiologists communicate about diagnostic errors
  16. Routine coagulation testing in Vacutainer® Citrate Plus tubes filled at minimum or optimal volume
  17. Diagnostic accuracy of fine needle aspiration cytology of thyroid nodules
  18. Letter to the Editor
  19. The day God created man
  20. Case Reports
  21. Entamoeba histolytica liver abscess case: could stool PCR avoid it?
  22. A rare cause of subclinical hypothyroidism: macro-thyroid-stimulating hormone
https://doi.org/10.1515/dx-2019-0046
Keywords for this article
diagnostic error; feedback; radiology

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Learning and teaching aren’t the same – the need for diagnosis curricula in graduate medical education
  4. Mini Review
  5. Controversies in diagnosis: contemporary debates in the diagnostic safety literature
  6. Opinion Paper
  7. Balancing confidence and humility in the diagnostic process
  8. Point/Counterpoints
  9. Roots of the total testing process
  10. Total testing process: roots and state-of-the-art
  11. Original Articles
  12. Embedding a longitudinal diagnostic reasoning curriculum in a residency program using a bolus/booster approach
  13. Structured case reviews for organizational learning about diagnostic vulnerabilities: initial experiences from two medical centers
  14. Breakdowns in the initial patient-provider encounter are a frequent source of diagnostic error among ischemic stroke cases included in a large medical malpractice claims database
  15. Perspectives from the other side of the screen: how clinicians and radiologists communicate about diagnostic errors
  16. Routine coagulation testing in Vacutainer® Citrate Plus tubes filled at minimum or optimal volume
  17. Diagnostic accuracy of fine needle aspiration cytology of thyroid nodules
  18. Letter to the Editor
  19. The day God created man
  20. Case Reports
  21. Entamoeba histolytica liver abscess case: could stool PCR avoid it?
  22. A rare cause of subclinical hypothyroidism: macro-thyroid-stimulating hormone
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