Perceptual error and the culture of open disclosure in Australian radiology

Abstract

The work of diagnostic radiology consists of the complete detection of all abnormalities in an imaging examination and their accurate diagnosis. Errors in diagnostic radiology comprise perceptual errors, which are a failure of detection, and interpretation errors, which are errors of diagnosis. Perceptual errors are subject to rules of human perception and can be expected in a proportion of observations by any human observer including a trained professional under ideal conditions. Current legal standards of medical negligence make no allowance for perceptual errors, comparing human performance to an ideal standard. Diagnostic radiology in Australia has a culture of open disclosure, where full unbiased evidence from an examination is provided to the patient together with the report. This practice benefits the public by allowing genuine differences of opinion and also by allowing a second chance of correct diagnosis in cases of perceptual error. The culture of open disclosure, which is unique to diagnostic radiology, places radiologists at distinct medicolegal disadvantage compared with other specialties. (i) Perceptual error should be acknowledged as an integral inevitable part of diagnostic radiology; (ii) culture of open disclosure should be encouraged by the profession; and (iii) a pragmatic definition of medical negligence should reflect the imperfect performance of human observers.

Ethical problems in radiology: medical error and disclosure

“…In the United States, a number of healthcare organisations have managed to reduce expenses due to medical malpractice suits by applying a policy whereby the physicians and hospital managerial staff not only disclose errors but admit blame and offer compensation [29]. Even in Great Britain and Australia, a policy of maximum transparency (open disclosure) is followed [13]. Some healthcare organisations have adopted a policy of "absolute honesty", according to which the patient who has suffered the error is fully informed, receives care and is compensated.…”

“…They appear to be significantly correlated with a number of psychophysiological factors, such as the level of alertness of the radiologists, which in turn depends on physical and mental fatigue and therefore on work-related stress, and on their state of visual tiredness, which depends on ergonomic conditions of the work environment, the duration of the visual task, and therefore on the pauses and workload. Such a complex pattern explains why this type of error cannot be completely eliminated, even though specific techniques have been developed and taught that make up good radiological practices and are aimed at reducing the rate of perception errors [13].…”

“…Esso appare significativamente correlato con numerosi fattori psicofisiologici, come il livello di allerta del radiologo, che a sua volta dipende dalla fatica fisica e mentale e quindi dallo stress da lavoro, e il suo stato di affaticamento visivo, che dipende dalle condizioni ergonomiche dell'ambiente di lavoro, dalla durata dell'impegno visivo, e quindi dalle pause e dal carico di lavoro. Un quadro così complesso rende ragione del perché non sia possibile eliminare del tutto questo tipo di errore, nonostante siano state messe a punto ed insegnate tecniche specifiche, che rientrano nelle buone pratiche radiologiche, finalizzate proprio a ridurre il tasso di errori percettivi [13].…”

Errors in imaging of traumatic injuries

“…Perceptual errors, in general, can be related to multiple cognitive and physiological factors, including level of observer alertness or fatigue, duration of the observation task, any distractions, conspicuity of the abnormality as well as many others [61].…”

The ‘radiographer–referrer game’: image interpretation dynamics in rural practice

“…Radiographic image interpretation involves high‐level skills and complex decision making, and there is a risk that errors may compromise patient care 2, 3, 4. Although some degree of error in radiographic image interpretation is unavoidable,5 these errors may be reduced by interprofessional collaboration2, 6 between the referrer and the radiographer.…”