0:00

Another thing that I highly recommend is

0:03

understanding your standards.

0:05

Now you realize that one of the components

0:09

of a medical legal case is a deviation from the standard

0:13

of care, and that deviation of the standard of care requires

0:17

that you understand your standards.

0:19

And the standard of care refers to

0:23

what a reasonable individual would do in a similar

0:27

situation and environment.

0:29

So that means that there is a standard of care

0:32

for working at Johns Hopkins

0:34

that may be different than the standard of care

0:37

for working at, uh, a community hospital

0:41

in a very small town where it's dominated

0:44

by general radiologists as opposed

0:46

to subspecialty radiologists.

0:48

So understanding the standards

0:50

and even the standards of your hospital.

0:52

If your hospital says that you have to withhold Pepin

0:56

for 48 hours prior to an interventional procedure,

1:00

but the a CR, the American College of Radiology says, uh,

1:04

just hold it for 96 hours, you're actually bound

1:08

by the standard of where you are practicing it.

1:11

That's the hospital.

1:12

Then you are, you have to know your hospital standards.

1:16

So what a reasonable physician would do in a similar

1:19

circumstance defines sort of the standard of care.

1:22

So your institutional rules may be

1:26

what is applied at a medical-legal malpractice

1:32

court case as opposed to a national standard.

1:36

Now, a lot of times the lawyers will bring out national

1:40

standards, and those are largely seen these days

1:46

in the a CR practice parameters.

1:48

So it's interesting over the course of my experience

1:51

and career and radiology, the A CR initially had standards,

1:57

and then because lawyers were using those standards

2:01

to prosecute against defendant radiologists,

2:05

the A CR changed the term to guidelines.

2:09

Uh, unfortunately, guidelines

2:11

and standards were close enough that

2:15

the lawyers could still say to the defendant,

2:18

you did not meet the a CR guideline.

2:21

So they changed the terminology once again, most recently

2:25

to practice parameters.

2:27

So these are not standards, they're not guidelines,

2:30

they're not even recommendations.

2:32

They're practice parameters.

2:34

And this is all in the hopes that, you know, the,

2:38

the lawyers won't apply the a CR practice parameters

2:44

as a standard of care in a medical-legal case.

2:47

Same similarly with treatment guidelines, um, uh,

2:51

anaphylactic reactions.

2:52

You really have to know what your hospital

2:54

or what your practice, um, requires you to know

2:59

And to perform in that setting.

3:03

So for example, um, Elliot Fishman, who, um, many of you

3:07

probably know, he's a brilliant body radiologist

3:12

who has this website, CT is us that is, you know, has

3:16

multiple tens of thousands of viewers.

3:19

He, um, had his own way of doing

3:25

prophylaxis for anaphylactic reactions at at,

3:29

with giving intravenous ID contrast

3:31

that actually differed from

3:34

what the A CR recommended.

3:38

Um, and what he would say

3:40

to us in the radiology department is, I haven't known this

3:42

for 40 years, and when I give this the regimen,

3:46

I've never seen anyone have a

3:48

anaphylactic reaction with this regimen.

3:50

And this is what we're using. I'm the head of body ct.

3:52

So even though this practice differed

3:57

from that of the a CR, it was the local standard

4:01

and was written in our books.

4:03

And so even though trainees would come from other

4:07

institutions and would try to apply the a CR guideline,

4:10

which they had been taught at the other institutions,

4:12

we had a local practice of how we did

4:17

anaphylactic um, reaction prophylaxis.

4:20

So the standard might vary from one practice to another,

4:24

might vary from one hospital

4:26

to another, one area from the other.

4:28

But be careful because you have to know the

4:31

national standard often at the time of trial.

4:34

This is the a CR practice parameter for communication

4:38

of diagnostic imaging findings.

4:41

And you know that this is the issue.

4:44

Non-routine communications.

4:45

When you find a mass that was unexpected,

4:49

when you find an aneurysm

4:50

that was unexpected when you find a stroke

4:52

that was su suspected, what are the

4:56

guidelines, practice parameters

4:59

for communicating those findings to the clinicians?

5:03

And I won't read this to you, um,

5:05

but you should know the a CR practice standard on

5:09

communication because I've been at multiple

5:13

medical-legal depositions

5:14

and trials where this was an issue

5:16

that the radiologist did not

5:19

call the clinician about a particular finding

5:21

that could have caused immediate harm to the individual

5:25

or even an incidental finding that should be worked up.

5:29

So, um, critical care units, pneumothorax, pneumoperitoneum,

5:34

misplaced lines or urgent conditions

5:36

that may be considered critical to patient care as well

5:40

as incidental findings that are important

5:44

that a workup be completed.

5:47

So you ought to read this carefully

5:50

and understand what our obligations are, at least according

5:53

to the a CR practice parameter.