What are the common consequences of say, being by yourself on call as a resident and coming back with a subpar report, or missing something obvious? Is it common to get reamed out by the surgeons/other consulting docs who pick up on your mistake, even if it's something relatively minor? Will your radiology attending make an example of you the next day?
What happens when you make a bad call as a DR resident?
- Thread starter odyssey2
- Start date
Depends how bad we're talking about and depends on what setting. Some places don't really have much independent overnight call anymore. In places where you still have several hours of independence (I'm talking about at least 12am-8am)...
No to small clinical impact (e.g. missed tiny subsegmental PE without heart strain, mild colitis, etc.): Nothing really, especially if there's no clinical change in management and the attending doesn't need to do a callback. If they do, you might slightly tick off the rad attending for the day reading out your cases but they'll forget about it.
Moderate impact: Same as above mostly except a bit worse.
Large impact (e.g. missing an obvious perforated appendicitis): Referrer and attending will be ticked off. You almost certainly WILL NOT be sued if you're worried about this. And if this is something rare for you, especially as a junior, there is no lasting impact. Obviously if it's a pattern there is an underlying issue and your PD will talk to you. To be honest I don't know a single person who has had this issue so I'm not sure where this leads... presumably if we're anything like other specialties then you'll have some form of remediation. I would assume an added extra block of dedicated ER readouts or something of that nature.
Massive impact (e.g. missed an obvious pathology that led to patient death or severe disability that could have been averted... something like a main pulmonary artery PE, severe bowel ischemia, acutely occluded carotid): You/your attending/your department will almost certainly receive a complaint from the referrer and your attendings will be pretty unhappy. You'll feel guilty about the bad outcome for the patient. There will be some chance of medicolegal action (while it still isn't that common, there is enough of a risk it'll keep you up at night). If it is a one off, you won't be fired. If it is a pattern... I would imagine remediation as the lightest form of action.
--------------------------------------------------------------------------------------------------------------
Overall I really wouldn't worry too much about it. Massive misses are very, very, very rare. The pathologies here tend to be more obvious too. The times where I have heard of these occurring are the ward equivalent of putting out an order on the wrong patient who shares the same name. Obviously you want these sort of misses to be "never events".
Large misses may happen a few times during the course of a whole radiology residency. Usually it isn't as clearcut as a complete miss, but rather, some degree of clinically significant undercalling, which I would downgrade to a "moderate impact miss".
Radiology residency isn't that different from others in this sense. There are certain diseases that as a resident you should essentially never miss even as a junior. Ortho and severe compartment syndrome, IM and severe DKA, ER and obvious STEMI, etc.
Last edited:
- Joined
- Dec 9, 2004
- Messages
- 4,510
- Reaction score
- 2,830
Most people who make it to the point of taking call as a radiology resident are prudent, diligent, and intrinsically motivated enough that the feeling of knowing they missed something is sufficient. I took overnight in-house call sans attending for 3.5 years, and, although I don't think I had any misses that would be considered to be life-altering or life-threatening, I definitely had misses. I know that I felt like dog****, and that feeling motivated me to do better the next time. Having to make the call of shame, usually to the ED, the next morning was pretty motivating as well.
People don't generally miss things due to lack of diligence or even knowledge. It's usually either a failure to observe a finding (because this is inevitable over a large enough sample size) or an error in interpretation of an observed finding. If a resident is missing things because they're lazy (e.g. not following a search pattern) or lack the appropriate fund of knowledge, then a pattern will emerge that needs to be addressed at a more fundamental level. Regardless, making an example of someone who is post-call doesn't remedy the situation, at least, IMHO.
Is it uncommon to be made an example of post-call if you do miss something?
- Joined
- Feb 10, 2016
- Messages
- 903
- Reaction score
- 995
That's bad organizational culture.
- Joined
- Dec 9, 2004
- Messages
- 4,510
- Reaction score
- 2,830
In my experience, yes, it's uncommon. That said, academia is replete with radiologists whose behavior would get them fired in just about any other workplace.
And to be clear, I'm not talking about correcting mistakes, even sternly, that need to be corrected. I'm talking about the dressing down of a trainee in a manner that's primarily designed to make the staff feel better about him/herself.
- Joined
- Jan 25, 2007
- Messages
- 1,077
- Reaction score
- 1,962
Extremely uncommon and unlikely.
We used to get passive aggressive e-mails from the neurorads about minor stuff because they were the most anal retentive humans on the planet but about that's it.
I've never heard of a resident missing something so bad overnight that the patient suffered real harm but obviously it will happen somewhere sometime. Either the finding will be subtle and no one will really fault you or it will be fairly obvious and people will wonder how you missed it and the Attendings will not trust you as much probably for the rest of your training because you missed that one big PE or whatever.
If you get unlucky or are distracted and miss more than 1 big thing that causes harm you may or may not be taken off call duties until they trust you again.
- Joined
- Oct 12, 2012
- Messages
- 2,083
- Reaction score
- 4,193
Never happened at my residency.
If I missed something, I would get constructive feedback for it from my attending. I would neither be made an example nor I would be ridiculed.
- Joined
- Jul 7, 2009
- Messages
- 705
- Reaction score
- 8
I do want to mention that even if your program has independent call, you're never truly alone. We don't practice radiology in a vacuum. If the patient is really that sick, you're going to have clinicians calling to ask "are you sure that study is normal? the patient is really sick", ordering the CT for further evaluation if you missed the fracture on radiographs, surgeons looking for the appendix on the CT themselves, etc. Thankfully, such adverse events tend to be extremely rare.
