In a followup to our prior post about following up on concerning findings, we explore who is responsible for reporting incidental radiology findings. Who was responsible for the patient not being told about a finding that could, if not detected, result in metastatic cancer and possible death? From our actual case, the possibilities are:

(1) the radiologist, who of course had no contact with the patient,

(2) the night ER doctor who did not think this was his responsibility,

(3) the day ER doctor to whom the final report was sent, but likely never saw it because the patient by then had been admitted to the hospital for emergency surgery,

(4) the ER department itself for not forwarding the report directly to the surgeon who was, by then, caring for the patient,

(5) the surgeon, who did not read the report but reviewed the actual film to better understand what surgery would be needed,

(6) hospitalists and other providers who, during the patient’s five-day stay in the hospital, could have reviewed the electronic records and noted the serious incidental finding, and

(7) the hospital itself for not having any “system” in place to ensure that significant incidental findings are reported to a patient.

Hospitals have responded to this problem in various ways. Many hospitals have rules to ensure that the doctor who ordered the imaging film must advise the patient and note that he did so in the electronic records. Some ER departments have a designated nurse who has the responsibility to ensure that a report — received after the ordering ER doctor is no longer on duty — is forwarded to either the patient or to the primary care physician or other providers caring for the patient. 

One state, Pennsylvania, recently passed legislation that requires the radiologist or their group to directly contact a patient in the event of a serious incidental finding. Despite all of these approaches, this problem persists and many patients are not told about findings that could impact their health in future years.