Radiologists are physicians with specialized training in the interpretation of diagnostic scans including x-rays, CT scans, MRI scans, and other forms of imaging. They do not see or evaluate patients in person. Instead, their medical practice is focused on reviewing images on a computer screen, often off-site and away from the hospital.
In contrast, clinical physicians, including specialties such as emergency medicine, hospitalist medicine, internal medicine, neurology, and surgical specialties, actually see patients in person, interview them for a medical history, and order tests and studies to put together the complete picture of what’s causing the patient’s problems. Frequently, it’s appropriate for these clinical doctors to order diagnostic radiology scans.
A competent, conscientious radiologist is an asset to clinical doctors. They provide information that can point them in the right direction in making a clinical diagnosis.
On the other hand, a sloppy radiologist who misreads a scan can have a devastating impact on a patient’s clinical course and treatment. That’s what happened to one of our clients., Interestingly enough I took deposition of our client's radiologist today.
Looking back, it’s hard to see how the radiologist and clinical physicians missed the mark. The patient went to hospital emergency room because she had terrible abdominal pain, nausea, and vomiting. When interviewed by the emergency room doctor, the patient shared how she had been constipated for about five days. The patient also told the ER doctor that she had been diagnosed with volvulus that required surgical repair about six months earlier. The patient explained that the symptoms she was currently experiencing were the same that she had when she went to the ER with volvulus last time.
Volvulus is a dangerous condition where the mesentery or bowel loops become twisted. The only way to treat it is through surgery, which must be timely done to prevent bowel ischemia and necrosis. In other words, if a surgeon doesn’t untwist the affected areas, the blood flow and oxygen supply will be diminished or impaired, causing the bowel to die.
The ER doctor appropriately ordered a CT scan of the abdomen and pelvis. When a clinical doctor, physician assistant, or nurse practitioner orders diagnostic imaging, they have the opportunity to provide a clinical indication or reason for the scan.
We’ve handled many cases where this information was inaccurate or downright misleading—so bad that it almost seemed like the clinical doctor was trying to hide the ball from the radiologist. In this case, though, the clinical indication or reason for the CT scan couldn’t have been more accurate. The ER physician wrote in the order that the reasons for the exam included abdominal pain, nausea, vomiting, and a recent history of volvulus.
According to our radiology expert, who literally wrote the textbook used to teach doctors about abdominal radiology, the radiologist who interpreted the CT scan misinterpreted the scan as normal. The radiologist missed the fact that there were early signs of the characteristic whirled mesentery that would have led any prudent radiologist to mention it in the report.
Instead, the radiologist who read this abdominal CT scan sent back a normal report. The ER doctor, hospitalists, and other physicians involved in the patient’s care relied on the report as establishing that the patient’s severe abdominal pain and other symptoms weren’t caused by another belt of volvulus.
Unfortunately, they were all wrong. And according to our medical experts, the clinical physicians failed to exercise their own independent critical thinking to evaluate the patient’s whole picture. They settled on constipation as the cause for all the problems and treated the patient with laxatives, enemas, suppositories, and powerful pain medications.
For five days, the doctors saw the patient and noted how she was getting worse. In each of their notes, though, they pointed back to the CT scan that didn’t identify volvulus. It’s likely they turned off their brains and were blinded to the patient that was sitting right in front of them.
At today’s deposition of the defendant radiologist, we obtained some important testimony:
• A CT scan does not definitively 100% rule out volvulus.
• A CT scan does not definitively 100% rule out an internal hernia.
• Radiology scans (and radiology reports) are just one tool of many that a responsible, competent clinical physicians uses to make diagnostic and treatment decisions for the patients.
I believe that this patient’s case is terribly sad because she knew exactly what was going on with her body when she went to the hospital emergency room. She explained that she had volvulus and a surgical repair about six months ago and that her symptoms were identical to what she was currently experiencing.
The doctors just wouldn’t listen, though, because they were more interested in the CT scan interpretation than the patient they were supposed to be treating. The radiologist set in motion a course of poor, substandard care that led to this patient developing bowel necrosis that would’ve been avoided with proper diagnosis and timely surgical intervention.
If you’ve been seriously injured because of poor radiology, hospital, or medical care in Texas, then contact a skilled, top-rated Houston, Texas medical malpractice lawyer to discuss your potential case.