Friday, January 20, 2012

To report or Not to report


Another interesting question.

What should we do if the organization that we work in has inadequate software and work-stations for angiographies or some studies and yet force the radiologist on pay-roll to make the report. Simply said, you should refuse but being within an organization like this and saying no to these suboptimal images and lack of state of the art facilities, sometimes become difficult. Balance is between relationship and ethics at times. What should you do when such a situation arise? And this gets trickier when your colleague is game for all such suboptimal cases and becomes the star in the eye of the management (read owners).  In India this is a relatively common situation. Do we have a way out? What do you say to a study which is inadequately done and payment has been made and patient is unwilling to come back or equipments are insufficient and management does not like a NO?

Comments are welcome.


Follow up comments to this post on facebook by three prominent radiologists. What is your opinion?

Ahamad Mastan Mukarrab Inadequate / suboptimal studies should never be reported in the best interest of the patient,. We are responsible for the quality of report as well as quality of the study. Reporting a suboptimal study will never help the patient. Ethically we are correct if we do not report. Reporting just to win accolades of management or satisfy the management is absolutely criminal and unwarrented. This is my honest opinion.


Mallapragada Gopala Krishna Murthy Do not forget no child's or verysick pts invs are optimal including chest xray and whole of India doesnot have optimal eqpt and denying them diagnosis ,,,,,,ethical.?


Ahamad Mastan Mukarrab I have seen a chest xray posted on teleradiology with extensive possible developer artifacts completely obscuring the lung fields In a genuine patient with lung disease , Now what should i do ? what is ethical ? Should i report it as developer artifact? should I call it as lung opacity. Even in a sick patient a suboptimal radiograph or investigation would do more harm to the patient than good. If some information is available we should definitely report it and ask for a repeat investigation.


Ahamad Mastan Mukarrab sometimes the quality of CTS is affected by extensive uncontrollable movements of the patient involuntarily in such cases best way is to stabilise the patient first , and then send for ct scan or take anaesthetists help or choose an alternative investigation which is not movement dependent . There are many instances where patient movement artifacts are wrongly reported as bleed etc etc Is it justifiable ?


Vineet Marwaha Thats very correct Dr. Ahamad Mastan Mukarrab . i think radiologist should report as nobody else could see better. Ofcourse, comment pertaining to exposure and other physical characteristics must be mentioned.


Ahamad Mastan Mukarrab I have seen a DWI artifact in medulla which was wrongly reported as lateral medullary syndrome when the patient had no relevant clinical symptom


Vineet Marwaha people who have installed such systems are not going to change them for us. If it will go unreported, they would 'try' to get information by themselves anyway, but would not change the machines.


Ahamad Mastan Mukarrab I have huge list of examples of suboptimal studies which were wrongly reported in almost every case resulting in lot of diagnostic dilemma, and almost all the times the radiologist has reported under the pressure of the mangement .


Ahamad Mastan Mukarrab That is the tragedy of Indian system where there is no standardisation of radiology equipment or quality assurance . There are no stringent laws to address these issues. If we give wrong report on a suboptimal study How does it help the patient ?In the first place such centres using third grade equipment should be banned from practise.There is no other way.



Mallapragada Gopala Krishna Murthy A s a professional , i would report anything that is exposed and give whatever suggestions / riders/ clinical relvances/followups/labdata help that is needed to confirm/ expose - that is ethical according to me my freinds .


Mallapragada Gopala Krishna Murthy do not sinlge out Pvt centers and sit on judgemnts, becoz the whole ofthe govt setups are no better .


Sumer Sethi i think Dr Mallapragada Gopala Krishna Murthy sir is not following oour argument, if the case cannot be done on a certain machine, patient should be referred to next centre where it can as he is paying for it, instead giving a report with riders and just earning a few bucks for the centre owners and getting into the good books.. we all are game for reporting infants and emergency cases,..


Ahamad Mastan Mukarrab It has nothing to do with a private or government or charitable organisation. Reasonable acceptable quality with good report and immense benefit to the patient is the key. If patients treatment is getting compromised because of our report we should definitely avoid.


Vineet Marwaha Another point i would like to notify as far as CT/MR is concerned. I always wright down in the Technique: so and so images were taken on a so and so Tesla scanner of so and so company.port we should definitely avoid.

4 comments:

MGK Murthy said...

Yes I have sugg . never could blame the eqpt or others for not knowing the knowledge. Try to report the best and sugg the best and cheapest alt for everyone

Karunakaran said...

well I am for NOT TO REPORT side !!!!

I want to ascertain that our reports are documented one... and is valid for an indefinite period of time. our reports must be answerable to changing scenarios of this consumerised world. one has to think about the futuristic world where anything and everything can happen...

The following things, I ensure on my personal grounds and i dont enforce/ justify it.

1.I am yet to accept teleradiology , for the fear of inadequate history, lack of control over the protocol.

2. I hate institutes where Imaging console and reporing rooms were different, as one lose option to control the protocol and clinical examination.

3.I never accept substandard alternatives ( situations)like customized thermocol breast coils for breast MRI, using hand injections for thoracoabdominal imaging when injector goes off etc

4. I wont accept case based salary, as in due course encouraging ESCAPERS and greedy people.

5. not to forget at any time in life that doctors are there to treat patients with pneumonia... not there to see only pnemuonia.

6. compromises cuts off credibility !!! itz all or none.

Anonymous said...

Ahamad Mastan Mukarrab:: Inadequate / suboptimal studies should never be reported in the best interest of the patient,. We are responsible for the quality of report as well as quality of the study. Reporting a suboptimal study will never help the patient. Ethically we are correct if we do not report. Reporting just to win accolades of management or satisfy the management is absolutely criminal and unwarrented. This is my honest opinion.

Anonymous said...

Khaled Abd EL Baky we are clinician not only photogrphiers

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