A large number of medical malpractice lawsuits stem from the misdiagnosis or delayed diagnosis of a medical condition, illness, or injury. When a doctor’s diagnosis error leads to incorrect treatment, delayed treatment, or no treatment at all, a patient’s condition can be made much worse, and they may even die. That being said, a mistake in diagnosis by itself is not enough to sustain a medical malpractice lawsuit.
Errors in Diagnostic Tests
Sometimes a doctor fails to correctly diagnosis a condition because they relied on inaccurate results from laboratory tests, radiology films, or other types of tests. This can happen in one of two ways:
- The diagnostic equipment was faulty.
- Human error occurred — for example, the samples were contaminated or mixed up, the technician used an improper procedure, the test results were read incorrectly, or the technician or specialist missed something in an x-ray or pathology slide.
Many clinics and technologist do not want to talk about the fact that many technologists do miss pathology once a while most of the time are benign miss such as small normal cyst etc. I will talk about the sonography part.
Our radiologists in Canada depend on supposedly highly trained registered sonographers, to do the ultrasound exams for them.
The problem come from the lack of knowledge in techniques and pathologies for some sonographers ,Especially those who were not trained and graduated in recognized north American colleges, and do not know how to scan , where to scan, and which data is most important to the exam.
Many are doctors from other countries and they have great knowledge but the sonography registration and techniques is step by step protocols that must be followed to make sure that you cover all areas, and not using the phrase “ We do this in our country” this is here now so you must follow this country protocol plus the AIUM, SDMS, ARDMS, SONOGRAPHY CANADA Protocols.
Many managers now days in USA and Canada are cutting and skimming exam time from 40 min to 30 and now days 20 to 25 minutes per exam pushing the technologists to run like a horse and sweat like a dog and that is the big contributing factor behind these missing pathologies.
In the last 3 years working with new clinic here in Calgary I collected more than 230 missing pathologies , in my room only, It happened that the patients come for follow up or second opinion or changed the clinic . Imagine how many other missing pathologies they missed.
We have 5 diagnostic imaging groups here in Calgary; they work with general diagnostic, some does x-ray and ultrasound only. Some offers MRI and Ct scans.
Missing pathologies such as arm DVT, legs dvt, gall stones, renal stones, adrenal masses, liver masses and cysts, pancreas masses, thyroid tumors, parathyroid masses, testicular masses, spleen infarction, appendicitis, endometrial polyps that turned to be cancerous , fibroid, AML , hernias, varieties of MKS tears and the list goes on and on.
Some clinics are worse than others. Regarding the MSK ultrasound I found the majority who are doing the exam here are not qualified or registered with RMSKS, and they didn’t even do any home study course, or they had some hands on training from someone who is not registered with RMSK.
Flipping throw the Google and you tube is not enough to make you an expert in MSK, vascular or other exams.
No strict regulation at all, no body is enforcing the need for the registration of the specific area, so if you are registers in abdominal and OBS you should only do ultrasound in these areas and so on. The excuse is that the radiologist is in house!!! Who cares! The question Is if your brain is in house. Is your training is in house, in toned, and are you fit 100% to diagnose my problem as a patient.
I am not pointing a finger at the techs, but at the problem. If we don’t talk about it nothing will change. If we do not start somewhere nothing will change. If we don’t change our habits of scanning nothing will change, if we don’t learn new methods and keep open mind to learn more nothing will change.
To know a little is more dangerous than if you don’t know nothing at all.
Some technologist go beyond, and over diagnose something is not there at all. One clinic in Edmonton diagnosed 15 hernias in one year, and when the patients went to the hospital for their surgeries they found that they didn’t have hernias at all.
My uncle who is a general surgeon at one of the hospitals in Edmonton told me that only 2 cases were correct, and that 13 of the other hernias were false diagnosis in the last year alone. He investigated and found that all those hernias exams were done by the sonographers and not by the radiologist and none of the exams had a cine loop imaging to prove it.
That is why the radiologist must ask for cine-loop clips to prove it. Many sonographers do elbows ultrasound and they don’t even look at the ulnar nerve and they call the exam normal elbow ultrasound!!! And If they do the ulnar nerve, they take a picture of the ulnar nerve in a transverse and sagital section and call it normal, or put a measurement of the ulnar nerve area and call it a normal exam.
But very few do the ulnar nerve with the arm in extension and flexion position as this is the most important part of the exam to r/o ulnar nerve subluxation otherwise it will be misleading to say normal elbow ultrasound because the doctor assume you looked into the subluxation of the nerve.
The doctors who send these exams share the blame too , as they are sending patients to the clinics without blood test result , preg tests results, tsh test, urine test results , and without even touching and examining the patient at all!
No indication in the request form if is a Murphy sign or not , is there any rash, skin discoloration, fever, chills, vomiting , increased wcb etc . Or the send the patient with no request at all, wrong side of the exam been ordered, request with no signature and that will take time from the exam as the clerk need to confirm and need faxed report etc.
It is not MacDonald by heaven sake, I screamed at one of the resident doctor in Saskatoon. As he was in the ultrasound room with me ordering a thyroid exam and by the time I done the thyroid he wanted an urgent testes ultrasound , and then kept changing his mind and asking for different exam , Our radiologist gave him a piece of his mind later on. Every time I go to MacDonald I remember that radiologist student, he is a good friend now working in a small town in Alberta.
Doctors, please do your job right before sending your patient to diagnostic exams, because in the court of law everybody will be brought to answer the question, from the doctor to the tech.
Quantity over quality is taken over the diagnostic managers to make money and the talk of quality work is only a talk, nothing less, Quality work is great in front of the news and the patients, but only 10% of those clinics do care for quality work. They want the numbers, they want to see that they are expanding, and they hate it when other group open a new clinic.
I will not be impressed with new technology until I can download food , But I am impressed with the technologist who goes the extra mile to find what is wrong with the patient .
Again 220 missing pathologies from all over the clinics in Calgary in my room alone in less than 3 years are too much. We all miss a small cyst or small stone or sludge but missing tumors, dvt, pancreatic masses that turned to be cancer and renal mass that turned to be cancer is a dangerous miss. We are all responsible , every body is responsible starting for the clerk who book the wrong exam, give the wrong preparation or wrong information , to the patient himself who come late ,and cut the exam time short, and arrived un prepared without a full bladder , to the doctors who send those patients without even seen them .
Sometimes the doctors talk to the patient by phone ! When a patient call them and ask for an ultrasound exam, they give us a verbal request and the doctor fax a request form later .
Some physician who send those patients by phoning the clinic asking for renal stone? we found appendicitis or gall stones. They ask for appendix and we found a hernia or ectopic pregnancy etc.
It is sad situation, and when those clinics meet and go front of the media they talk the talk as no one in earth better than them .They always mention that ” we have got new machine” , new tools , we are the first one in town to have this machine . well that is good but before you invest in your machine invest in your technologists , build the team brain first , send them for training and re training, push them to have registration and qualification for each exam , if they cannot do it ask why , otherwise get rid of them.
Time is changed and doing the same thing as we used to do it 36 years ago is not good method. All sonographers must take the new SPI physics exam to start with , give them 2 years to pass, then ask them to take the MSK, Vascular etc….If he or she passed abdominal ultrasound ask her not to touch OBS us without supervision until they do pass the exam. When I stop learning I stop working.
Same with MSK exam if you don’t pass it don’t touch it without supervision. I can write a book about this subject that impact our patient care, quality of work and our stress level due to quantity over quality. It will affect us one day when we get older and retired and we need an ultrasound exam. We need to make sure that we are been examined by well qualified well trained sonographers, and not just registered. We must ask the office before booking the exam are your sonographers is registered with this specialty if not , you can ask for someone who is qualified to book your exam with to be in a good hand and that is your right.
We must start now to focus on our quality technologists before buying a new machine, and focus on the real patient care and quality before quantity.
We must regulate the number of cases that each sonographer must do, and make it a bylaw to not exceed specific number per working day. And if the managers go overboard with the numbers they must be brought to investigation by the college in each province, or the union, or any other ministry of health quality control office or the Director of the place.
Thanks for reading.
Steve Ramsey, PhD. Calgary, Alberta – Canada.