Case study: Radiologists should be cautious when delivering 'bad news'

For patients, receiving the results of radiology reports can prove to be stressful experiences. The moment after the information is shared, they will either be breathing a sigh of relief—or the complete opposite.

In a recent article published in the American Journal of Roentgenology, a radiologist was found negligent in the case of a psychiatric patient in Israel who died by suicide after receiving a radiology report sent directly to him and reading the results as "bad news."

Leonard Berlin, MD, and his colleagues describe the case of a 51-year-old man who had been diagnosed with lung cancer and underwent surgery. This was followed by a PET/CT scan that found no metastatic disease and radiation treatment. He was treated for depression following this therapy and prescribed antidepressant medication. He then received another PET/CT scan six months later, which showed, “the pathologic uptake in the mediastinum had decreased markedly.”

Two days later, the man received a radiology report sent to him at his home address. He opened the sealed envelope and read aloud, “Pathological uptake in a mediastinal lymph node, less prominent than before.”

He threw the letter on the table and told his wife, “You told me that I am healthy.” She explained to the court that in the following hours, he was distressed and was not acting, “like his usual self.” The next morning, she discovered he had hanged himself from a tree in the backyard of their home.

Following the suicide, the patient's wife filed a malpractice lawsuit alleging, “the radiologist and oncologist were aware that the patient had been undergoing psychiatric treatment of depression, [and] they acted negligently by sending the radiology report directly to the patient at his home,” the authors wrote. The lawsuit was filed against the hospital partly because practicing physicians rarely sued personally in Israel.

Since the man suffered from depression and received this “breaking bad news,” the judge ultimately awarded 1.5 million Israeli Shekels (approximately $400,000) be paid to the patient’s family.

Although this lawsuit took place in Israel and has no impact on U.S. laws, Berlin and colleagues thought it fitting to stimulate the minds of the radiologic community into thinking about the format and manner of delivering examinations, especially in a time where electronic communication has become dominant.

“Radiologists must take care not to forget to alter a standard template when necessary, and they must carefully proofread every radiology report. Failure to do so could easily convert a ‘good news’ report into a ‘bad news’ report,” the authors wrote. “Whether the news be good or bad, radiologists should make every effort to avoid medical jargon and use language that patients will understand and accept with equanimity."