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With many radiology cases, it is only in hindsight — with the knowledge that there is, in fact, an abnormality — that the abnormality can then be identified by comparison.¹ Consider how the outcome of this case might have been different if the second radiologist had more thoughtfully reported the discrepancies in imaging interpretation.

Some (fortunately rare) patient actions, such as a patient’s threat to harm a physician, call for immediate termination with no intermediate treatment period. Other patient actions, such as non-payment of bills or noncompliance with care recommendations, are reasons for termination but do not eliminate a physician’s duty to give a patient sufficient notice to obtain alternative medical treatment. Consider the following case, in which the physician believed the patient’s initiation of legal action against his partner justified his immediate termination of the patient relationship.*

Incidental findings of lung nodules are common and frequently missed. Many of these missed nodules are clinically irrelevant.¹ However, when a patient who is diagnosed with advanced lung cancer discovers there was an unreported incidental finding during a period when the lung cancer was treatable, a negligence claim is likely. Consider how improved communication could have affected the outcome of the following radiology case study.

Misdiagnosed breast cancer is one of the most common claims against radiologists.¹ Although much of the onus for ensuring that follow-up occurs is on the referring physician, all providers involved in the patient’s care should establish and then follow policies on communication of radiologic diagnosis and testing. Had communication roles been clear, this patient’s breast cancer could have been discovered earlier and a lawsuit could have been averted.

Every year, NORCAL companies risk management specialists receive numerous telephone calls about terminating patient relationships. This case study describes a typical scenario.