Impossible errorsBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2427 (Published 05 June 2018) Cite this as: BMJ 2018;361:k2427
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Maskell fails to identify the co-conspirator in his impossible errors - the referrer. The quality of the report is highly dependent on the quality of the referral, setting the context in which images are assessed. If thinking about the implications of a possible outcome of a radiological investigation is outsourced to the future, the radiologist is placed in a difficult position. Furthermore, the patient has to wait whilst the referrer considers the results and does the necessary thinking post hoc - worse still, when thinking is outsourced to an electronic order set. Even if it were possible to spot every incidental mass and abnormality on imaging, the consequences for patients are likely to be mixed at best. Where cross sectional imaging technology is more accessible, the concept of Victims Of Medical Imaging Technology is well established.
An SBAR approach to constructing an imaging referral and more focus on the training of future referrers must be part of the solution. Even better, where matters are complicated, going and talking to the radiologist about the referral will often help to refine the imaging protocol and aid in subsequent useful interpretation of the result. If the referrer goes on a fishing trip, is it any wonder that the radiologist hides in a darkened room behind a hedge?
Competing interests: No competing interests