Consequences of misses

[deleted674723]

I have seen many people mention on this board and in other discussions that a major factor in their hesitation to pursue or regret after choosing radiology is due to the constant fear of missing something on a read. I am considering radiology very heavily as an MS3, but I know that I am a generally nervous/worrisome person who tends to fixate on things. I can see myself staying up all night worrying about the 100+ reads I did that day and wondering if I missed something. This could easily make me miserable.

Can anyone comment on how pervasive these feelings are once training is complete? Is this a legitimate reason to pursue a different field? What are the consequences of misses? Will one bad day ruin the decade of time and effort I will have put into my career?

Thank you.

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[colbgw02]

Can anyone comment on how pervasive these feelings are once training is complete?

There's a steep learning curve once you're out of training. Probably not as steep as an R1, but still, I think we all have a period where we're on edge knowing that no one else is overreading us. How quickly you become comfortable has more to do with your personality than anything else, but obviously most people find a practice style and speed that match their own.

Is this a legitimate reason to pursue a different field?

You're really the only one that can answer that. Anxiety occurs above the tentorium, so you're the only one that can decide if you'd be happier doing something else.

What are the consequences of misses?

Usually nothing. You learn; you get better. I think we can all name a few of our own misses that hit like a ton of bricks and probably changed the way we practice.

Will one bad day ruin the decade of time and effort I will have put into my career?

In my opinion, there is not a positive correlation between being a good radiologist and getting sued. Considering the way our system punishes undercalling, one could argue that there may even be a negative correlation. But what's much more likely to be true is that it's a crapshoot and being sued in no way is reflective of your skills or how you performed on a specific case.

The number of sued radiologist practicing today is legion, whereas having a settlement go against you is uncommon. Even then, that's why you have insurance. I don't stay up at night worry about some plaintiff's attorney taking my house or my kids' college funds. What I do dread is the emotional and psychological toll that a lawsuit can have, but there's nothing to be done about that. Lawyers name everybody who shows up in the chart and then figure it out later.

 

[Radology]

I see egregious misses from a number of my colleagues every week, as well as some of my own.

Say you read a turtle pace of only 30 Abdominal cts a day. That’s roughly 30,000 images a day. 7.5 million images a year of 250 work days. Missing is unavoidable.

The consequences range from never knowing/nothing happening to causing significant patient morbidity.

If you cannot handle the stress, I would think long and hard; the worst radiologists I know are the ones who live in constant fear of missing. A little stress is great for motivation to improve; too much is crippling.

 

[Dave1980]

The truth is that most misses don't matter, most misses that matter will get caught on followup, and most misses that matter that don't get caught on followup don't cause enough damage to warrant a law suit.