The responsibility for being right.

Abstract

Often in the practice of diagnostic radiology a clinician upon referring a patient to us will reaffirm the oft-repeated shibboleth that the responsibility for the patient is his—the clinician's—and that we are consultants, no more and no less. This erroneous concept has proved false repeatedly in all spheres of radiology from the smallest private office or radiology department to the very large academic teaching units, as diagnostic radiology has established itself so spectacularly in this modern era. Either the clinical diagnosis is confirmed in most cases by the radiologist, or a diagnosis totally unsuspected by the clinician is definitively established by the radiologist. Thus, in actual fact, the radiologist is more responsible for the fate of the patient in many instances than any other physician involved with him. Once one accepts this premise, it is obvious that an important burden rests on the radiologist in every given situation involving the radiologic examination of the patient. In truth, then, the radiologist has a real responsibility for being right. There are different levels or gradations of being right, from a totally correct diagnosis to a meaningful suggestion that alerts the clinician to a possibility whose actual presence is established or negated only by pertinent clinical evidence and∕or laboratory data. In his Shattuck Lecture (6) in 1950 the late Merrill Sosman described 7 groups of deductions in evaluating a roentgen examination. These included absolutely certain (e.g., fracture); highly probable (e.g., renal or vesical calculi); probable (e.g., pulmonary infarct); possible—unable to differentiate between … (e.g., atypical disseminated miliary pulmonary disease); minor changes of no clinical significance (e.g., pleural scars); normal; and normal in the face of positive signs of disease. Dr. Sosman added an eighth group which he euphemistically called “Sosman's psychological side step”— an interpretation that makes the clinician aware of the possibility of a diagnosis though it can be suggested only in a negative way (e.g., a minor alteration in the porus acusticus of a petrous pyramid which might be a normal variant but could also indicate a small acoustic neurinoma). As I was thinking this summer about the various implications of the foregoing while working on this address, my younger son asked me one day to name the teacher who had made the greatest impact on me in school. I answered without hesitation that it was Dr. Thomas J. LeBlanc who was the Professor and Chairman of the Department of Preventive Medicine and Public Health at the College of Medicine of the University of Cincinnati.