Mandating Limits on Workload, Duty, and Speed in Radiology.

Research has not yet quantified the effects of workload or duty hours on the accuracy of radiologists. With the exception of a brief reduction in imaging studies during the 2020 peak of the COVID-19 pandemic, the workload of radiologists in the United States has seen relentless growth in recent years. One concern is that this increased demand could lead to reduced accuracy. Behavioral studies in species ranging from insects to humans have shown that decision speed is inversely correlated to decision accuracy. A potential solution is to institute workload and duty limits to optimize radiologist performance and patient safety. The concern, however, is that any prescribed mandated limits would be arbitrary and thus no more advantageous than allowing radiologists to self-regulate. Specific studies have been proposed to determine whether limits reduce error, and if so, to provide a principled basis for such limits. This could determine the precise susceptibility of individual radiologists to medical error as a function of speed during image viewing, the maximum number of studies that could be read during a work shift, and the appropriate shift duration as a function of time of day. Before principled recommendations for restrictions are made, however, it is important to understand how radiologists function both optimally and at the margins of adequate performance. This study examines the relationship between interpretation speed and error rates in radiology, the potential influence of artificial intelligence on reading speed and error rates, and the possible outcomes of imposed limits on both caseload and duty hours. This review concludes that the scientific evidence needed to make meaningful rules is lacking and notes that regulating workloads without scientific principles can be more harmful than not regulating at all.

Fear of Being Fired for Malpractice and Failing Up.

Malpractice is one of the biggest fears that physicians have. Such an allegation has serious ramifications for radiologists. In this article, I discuss a rare but important example of how a lawsuit against a radiologist led to failing up and an unexpected outcome.

Speed Versus Interpretation Accuracy: Current Thoughts and Literature Review.

OBJECTIVE. Whether there is a precise relationship between reading speed and diagnostic accuracy has been an elusive and much debated issue. We discuss the literature and include practical considerations and relevant experience. CONCLUSION. To our knowledge, no credible relationship has been established between the speed of diagnostic image interpretation and accuracy. Furthermore, no nationally recognized guidelines address these factors, and it would be irresponsible to attribute widespread credibility to anecdotal studies. A variety of factors influence diagnostic accuracy, and length of interpretation time is not an established one.

Contemporary Risk Management for Radiologists.

Although radiologists want to avoid being sued for malpractice, their primary objective is to treat patients in the best way possible. Good risk management safeguards both patients and radiologists. The main objective is not to wait until an untoward event occurs and then manage it retrospectively, but rather to anticipate what may go wrong or cause an injury, so that it can be avoided. Thus, good risk management is characterized by two words: anticipate and avoid. Although avoiding lawsuits is the apparent objective of risk management, the real objective is to optimize the care and treatment of patients. Potential causes of error and injury must be identified to prevent such problems from occurring so that the conduct of radiologists allows patients to benefit from their knowledge and technology. If radiologic diagnoses and treatment are beyond reproach, then malpractice suits are less likely. The most common and potentially injurious risks that should be anticipated and avoided are closely entwined with radiologic diagnosis, incidental findings, communication of findings to referring physicians, "curbstone consultations," disclosure of and apology for errors, breast density laws, American College of Radiology parameters, radiation exposure, the Health Insurance Portability and Accountability Act, electronic health records, and imaging traumatic brain injury with functional MRI. Peer review and the current status of the medical malpractice environment are also relevant. ©RSNA, 2018.