The Royal College of Radiologists fully supports the principles of openness and transparency in relations between doctors and patients. In particular we recognise the responsibility of all health professionals to be honest with patients when things have gone wrong. Extensive research evidence shows that error is inherent in radiology. The current definition of the threshold set by regulators at which an apology and explanation must be offered to a patient means that there will be many occasions on which a radiological error or discrepancy may lead to the need for such a conversation.
In diagnostic radiology practice the relationship between doctor and patient differs from that in most clinical settings in that the patient is unlikely to have met the radiologist. This requires special consideration when it is decided that a “candour conversation” is required.
The Royal College of Radiologists will be issuing guidance to radiologists on their responsibilities in relation to the Duty of Candour in due course but, following discussion with the General Medical Council and Care Quality Commission, we feel it necessary to issue this interim statement establishing three important principles.
In general, in diagnostic radiology practice, radiologists are not best placed to assess the clinical impact of a radiological error or discrepancy. Radiological interpretation must always be integrated with clinical care. The failure to detect an abnormality on a radiograph, or the misinterpretation of the significance of a radiological finding is seldom the sole reason for a delayed diagnosis or misdiagnosis and the clinical impact of such an event may not be clear to the radiologist. Therefore, discussion of such cases in a radiological “Learning from Discrepancies” or “Quality Improvement” meeting should not include a formal assessment of the harm suffered by the patient as a result of any error. If it is suspected that harm has resulted, or could have resulted, the case should be referred for consideration either by the clinician currently responsible for the patient’s care, or to an independent clinical panel established within the employing organisation.
When it is felt after appropriate clinical input that a “candour conversation” with the patient or patient’s relatives is required, the most appropriate person to conduct such a conversation is a clinician with whom the patient has an active clinical relationship. This could be a clinician in primary or secondary care. If the patient has no current clinical relationship, perhaps because the identified error took place in the distant past, then the conversation should be initiated and conducted by an individual with specific training in the conduct of such conversations. It will seldom, if ever, be appropriate for a radiologist who has no current clinical relationship with the patient and no such specific training to be asked to conduct such a conversation.
If it is determined through the appropriate channels in a Trust or other employer that a candour conversation is required with a patient or patient’s relatives due to a radiological error or discrepancy, this should always be discussed in advance with a radiologist – and if possible with the radiologist whose original interpretation has proved erroneous – so that all factors which may have led to a misdiagnosis are understood and any lessons can be learned. A radiologist involved in the case should also be given the opportunity to participate in the conversation with the patient or patient’s relatives.
- NMC and GMC. (2015) Openness and Honesty when things go wrong: the professional duty of candour
- Care Quality Commission (2015) Duty of Candour: information for all providers: NHS bodies, adult social care, primary medical and dental care and independent healthcare. available at: www.cqc.org.uk/sites/default/files/20150327_duty_of_candour_guidance_final.pdf (last accessed 17/09/15)
- The Royal College of Radiologists. (2014) Standards for Learning from Discrepancies Meetings. available at: https://www.rcr.ac.uk/publication/standards-learning-discrepancies-meetings (last accessed 17/09/15)