Department of Radiology, Mid-South Imaging and Therapeutics and The University of Tennessee Health Science Center, Memphis, TN, USA.
AJR Am J Roentgenol. 2010 Jun;194(6):1552-8. doi: 10.2214/AJR.09.3863.
Plaintiff's Attorney (Pl Att:: Doctor, the record shows that the patient was referred to the hospital's radiology department by her gynecologist for a screening mammogram. The record also shows that when completing the mammography information form, the patient wrote that she had a lump in her left breast, correct? Defendant Radiologist (Df Ra:): Yes. Pl Att: But your technologist performed, and you interpreted, a screening mammogram. Doesn't the radiology standard of care require you to do a diagnostic mammogram when the patient has a breast lump? Df Ra:: Well, normally yes, but if it's going to be a diagnostic mammogram, then the referring physician has to order it. In this case our tech called the gynecologist and asked him whether he wanted to order a diagnostic study, and he said no, he didn't feel the lump, and that we should only do a plain screening mammogram. Pl Att:: Please explain something. You're agreeing that a woman with a breast lump should have a diagnostic mammogram, but you are saying that you didn't do one because the patient's physician wouldn't order it? Don't you have a duty to do the diagnostic mammogram in a case like this on your own, without having to ask permission from the patient's gynecologist? Df Ra:: Only the treating physician can change a screening mammogram into a diagnostic mammogram, and I am not the treating physician. If I went ahead and did a diagnostic mammography examination on my own, it would be Medicare fraud, and our hospital's compliance officer says it could result in our hospital being fined and thrown out of the Medicare program. Pl Atty: What prevents you then from recommending-not ordering, but just recommending-a diagnostic mammogram in your report, because the patient says she's got a lump? Df Rad: Well, according to our hospital's compliance officer, that would also be fraud.
原告律师（Pl Att:: 医生，记录显示，患者由其妇科医生转介至医院放射科进行乳房 X 光筛查。记录还显示，在填写乳房 X 光检查信息表时，患者写道她的左乳房有肿块，对吗？ 放射科医生（Df Ra:: 是的。Pl Att: 但是您的技术员进行了乳房 X 光筛查，而您进行了解读。当患者有乳房肿块时，放射科的标准护理是否要求您进行诊断性乳房 X 光检查？ Df Ra:: 通常是的，但如果要进行诊断性乳房 X 光检查，那么转诊医生必须下这个医嘱。在这种情况下，我们的技术员打电话给妇科医生，询问他是否要开一个诊断性研究，他说他没有摸到肿块，只做一个普通的乳房 X 光筛查就可以了。Pl Att:: 请解释一下。您同意有乳房肿块的女性应该进行诊断性乳房 X 光检查，但您却说因为患者的医生没有下这个医嘱，所以您没有做一个诊断性乳房 X 光检查？在这种情况下，您没有义务自行进行诊断性乳房 X 光检查，而无需征得患者妇科医生的同意吗？ Df Ra:: 只有主治医生可以将乳房 X 光筛查改为诊断性乳房 X 光检查，而我不是主治医生。如果我自行进行诊断性乳房 X 光检查，那就是医疗保险欺诈，我们医院的合规官员说，这可能导致我们医院被罚款并被逐出医疗保险计划。Pl Atty: 那么，有什么可以阻止您在报告中建议——不是下医嘱，而是只是建议——进行诊断性乳房 X 光检查，因为患者说她有肿块？ Df Rad: 嗯，根据我们医院的合规官员，那也是欺诈行为。
