Systemic lupus erythematosus (SLE) is a systemic autoimmune condition with many clinical presentations. It is classically seen in young to middle-aged females and can present with cutaneous, renal, serosal, hematological, joint, and/or neurological manifestations at the time of diagnosis or may develop over the course of the disease. Late-onset SLE or SLE in the elderly is a subtype that differs from the classic SLE in age group, clinical presentation, involvement of organs, and severity. Here, we present the case of a geriatric Hispanic male noted to have worsening renal function. The patient was diagnosed with lupus nephritis (LN) upon obtaining serological markers and renal biopsy. LN, a renal sequela of SLE, presents with a full-house immunofluorescence pattern. LN, along with high titers of the antinuclear antibody (ANA) and/or anti-double-stranded DNA (anti-dsDNA) antibody, is an effective tool to diagnose SLE in patients without extrarenal manifestations of the disease. The patient was managed with glucocorticoids and mycophenolate mofetil therapy, which led to a rapid downtrend of creatinine, resulting in stabilization of renal function and deferring the need for a hemodialysis. This case highlights the topic of late-onset SLE presenting with LN in geriatric patients.
OBJECTIVE. Whether there is a precise relationship between reading speed and diagnostic accuracy has been an elusive and much debated issue. We discuss the literature and include practical considerations and relevant experience. CONCLUSION. To our knowledge, no credible relationship has been established between the speed of diagnostic image interpretation and accuracy. Furthermore, no nationally recognized guidelines address these factors, and it would be irresponsible to attribute widespread credibility to anecdotal studies. A variety of factors influence diagnostic accuracy, and length of interpretation time is not an established one.
Reply to “The Speed-Accuracy Trade-Off”Lawrence R. Muroff1,2 and Leonard Berlin3,4Audio Available | Share
Although radiologists want to avoid being sued for malpractice, their primary objective is to treat patients in the best way possible. Good risk management safeguards both patients and radiologists. The main objective is not to wait until an untoward event occurs and then manage it retrospectively, but rather to anticipate what may go wrong or cause an injury, so that it can be avoided. Thus, good risk management is characterized by two words: anticipate and avoid. Although avoiding lawsuits is the apparent objective of risk management, the real objective is to optimize the care and treatment of patients. Potential causes of error and injury must be identified to prevent such problems from occurring so that the conduct of radiologists allows patients to benefit from their knowledge and technology. If radiologic diagnoses and treatment are beyond reproach, then malpractice suits are less likely. The most common and potentially injurious risks that should be anticipated and avoided are closely entwined with radiologic diagnosis, incidental findings, communication of findings to referring physicians, "curbstone consultations," disclosure of and apology for errors, breast density laws, American College of Radiology parameters, radiation exposure, the Health Insurance Portability and Accountability Act, electronic health records, and imaging traumatic brain injury with functional MRI. Peer review and the current status of the medical malpractice environment are also relevant. ©RSNA, 2018.
For the first 180 years following the founding of the US, physicians occasionally were sued for medical malpractice. Allegations of negligence were errors of commission - i.e. the physician made a mistake by doing something wrong, usually mistreatment of a fracture or dislocation, a complication or death following a surgical procedure, prescribing the wrong medication, and after the discovery of the X-ray by Roentgen in 1895, causing radiation burns. In the mid twentieth century malpractice allegations slowly changed from errors of commission to errors of omission - i.e. the physician failed to do something right: almost always, failed to make a diagnosis. The number of malpractice lawsuits increased at a geometric rate beginning in the 1960s, and in the 1970s physicians began practicing defensive medicine, which lead physicians to order unnecessary radiology exams and tests. In the past 20 years the number of malpractice lawsuits has been decreasing, but the practice of defensive medicine has continued. Unnecessary exams and tests increase the likelihood of overdiagnosis and overtreatment, i.e. a new kind of error of commission.
