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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / Singhal, Geeta / McDonald, Kathryn / Singh, Hardeep / Newman-Toker, David

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura

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Perspectives from the other side of the screen: how clinicians and radiologists communicate about diagnostic errors

Anna Lama / Jeffery Hogg / Andrew P.J. Olson
  • Corresponding author
  • Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
  • Department of Pediatrics, University of Minnesota Medical School, 420 Delaware St SE, MMC 741, Minneapolis, MN 55455, USA
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  • Other articles by this author:
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Published Online: 2019-08-15 | DOI: https://doi.org/10.1515/dx-2019-0046



Miscommunication amongst providers is a major factor contributing to diagnostic errors. There is a need to explore the current state of communications between clinicians and diagnostic radiologists. We compare and contrast the perceptions, experiences, and other factors that influence communication behaviors about diagnostic errors between clinicians and radiologists.


A survey with questions addressing (1) communication around diagnostic error, (2) types of feedback observed, (3) the manner by which the feedback is reported, and (4) length of time between the discovery of the diagnostic error and disclosing it was created and distributed through two large academic health centers and through listservs of professional societies of radiologists and clinicians.


A total of 240 individuals responded, of whom 58% were clinicians and 42% diagnostic radiologists. Both groups of providers frequently discover diagnostic errors, although radiologists encounter them more frequently. From the qualitative analysis, feedback around diagnostic error included (1) timeliness of error, (2) specificity in description or terminology, (3) collegial in delivery, and (4) of educational value through means such as quality improvement.


Clinicians and radiologists discover diagnostic errors surrounding the interpretation of radiology images, although radiologists discover them more frequently. There is significant opportunity for improvement in education and practice regarding how radiologists and clinicians communicate as a team and, importantly, how feedback is given when an error is discovered. Educators and clinical leaders should consider designing, implementing, and evaluating strategies for improvement.

Keywords: diagnostic error; feedback; radiology


  • 1.

    Allen B. The value of radiologists in reducing diagnostic error in health care. J Am Coll Radiol 2014;11:1101–2.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 2.

    Larson DB. Tackling the problem of error in diagnostic radiology. Pediatr Radiol 2015;45:790–2.Web of SciencePubMedCrossrefGoogle Scholar

  • 3.

    Waite S, Scott J, Gale B, Fuchs T, Kolla S, Reede D. Interpretive error in radiology. Am J Roentgenol 2017;208:739–49.CrossrefWeb of ScienceGoogle Scholar

  • 4.

    Siegal D, Stratchko LM, DeRoo C. The role of radiology in diagnostic error: a medical malpractice claims review. Diagnosis (Berl) 2017;4:125–31.PubMedCrossrefGoogle Scholar

  • 5.

    Bruno MA. 256 Shades of gray: uncertainty and diagnostic error in radiology. Diagnosis (Berl) 2017;4:149–57.PubMedCrossrefGoogle Scholar

  • 6.

    Waite S, Scott JM, Legasto A, Kolla S, Gale B, Krupinski EA. Systemic error in radiology. AJR Am J Roentgenol 2017;209:629–39.PubMedCrossrefGoogle Scholar

  • 7.

    Zafar HM, Bugos EK, Langlotz CP, Frasso R. Chasing a ghost: factors that influence primary care physicians to follow up on incidental imaging findings. Radiology 2016;281: 567–73.Web of ScienceCrossrefPubMedGoogle Scholar

  • 8.

    Singh H, Meyer AN, Thomas EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf 2014;23:727–31.CrossrefWeb of SciencePubMedGoogle Scholar

  • 9.

    Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med 2008;121(5 Suppl): S2–23.CrossrefWeb of SciencePubMedGoogle Scholar

  • 10.

    Croskerry P. The feedback sanction. Acad Emerg Med 2000;7:1232–8.PubMedCrossrefGoogle Scholar

  • 11.

    Meyer AN, Singh H. The path to diagnostic excellence includes feedback to calibrate how clinicians think. J Am Med Assoc 2019;321:737–8.CrossrefWeb of ScienceGoogle Scholar

  • 12.

    Cifu AS. Diagnostic errors and diagnostic calibration. J Am Med Assoc 2017;318:905–6.CrossrefGoogle Scholar

  • 13.

    Graber ML, Rencic J, Rusz D, Papa F, Croskerry P, Zierler B, et al. Improving diagnosis by improving education: a policy brief on education in healthcare professions. Diagnosis (Berl) 2018;5:107–18.PubMedCrossrefGoogle Scholar

  • 14.

    Balogh EP, Miller BT, Ball JR, editors. Institute of Medicine (U.S.). Committee on Diagnostic Error in Health Care. Improving diagnosis in health care. Washington, DC: The National Academies Press, 2015.Google Scholar

  • 15.

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81.CrossrefWeb of SciencePubMedGoogle Scholar

  • 16.

    Grubenhoff JA, Ziniel SI, Bajaj L, Hyman D. Pediatric faculty knowledge and comfort discussing diagnostic errors: a pilot survey to understand barriers to an educational program. Diagnosis (Berl) 2019;6:101–7.CrossrefGoogle Scholar

  • 17.

    Tsuei SH-T, Lee D, Ho C, Regehr G, Nimmon L. Exploring the construct of psychological safety in medical education. Acad Med 2019. DOI: https://doi.org/10.1097/ACM.0000000000002897.PubMed

About the article

Corresponding author: Andrew P.J. Olson, MD, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA; and Department of Pediatrics, University of Minnesota Medical School, 420 Delaware St SE, MMC 741, Minneapolis, MN 55455, USA

Received: 2019-06-18

Accepted: 2019-07-21

Published Online: 2019-08-15

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Diagnosis, 20190046, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2019-0046.

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