Controversy rages over sudden suspensions in Antwerp

It's a complete disgrace: That's the view of a spokesperson for Belgian medical specialists over the decision to suspend the full team of radiologists at ZNA Cadix in Antwerp.

In an article posted on 10 June by De Specialist, Dr. Rudi Van Driessche of the Belgian Association of Medical Syndicates (BVAS) voiced his anger about the collective replacement of the seven radiologists by hospital managers. He said he was shocked by the "unprecedented" action and the way it was done, and he hopes the doctors "will not let this just pass."

Van Driessche admits he does not know the details about the cases, but based on what has been released in the press, some of the errors are relatively trivial, such as a broken thumb being overlooked and the dimensions of a tumor being misjudged. "The quoted error rate of 1.84% can be called very good, especially in light of the huge workload that radiologists face today," he said. "Will this (the dismissal of radiology teams) become a new trend?"

BVAS has also voiced concerns about how the radiologists were suspended. It is worrying that hospital management passed on the results of an internal investigation to the media, the chair of the BVAS stated in a second article published by De Specialist on 10 June. "This damages the reputation of the radiologists and by extension discredits the entire medical profession. It also causes concern among patients. We can only hope that there are no other underlying motives behind this unprecedented measure."

It's essential to look at exactly what errors were involved, Prof. Johan De Mey, PhD, head of radiology at UZ Brussels, told VRT News in an article posted on 8 June. "If a clear brain hemorrhage has been missed, then I think this is very bad and unacceptable. But if they are errors because the correct examination was not requested, because it was difficult to see what the problem was on that examination, or because minor incidental findings were not seen, then I think that is much less serious."

De Mey said he finds the decision to suspend an entire team "peculiar," particularly when there is a shortage of radiologists in Belgium. Also, radiologists now have to process an enormous amount of images and data, and the new technology has made the job harder, he added.

"There must be something more going on," said De Mey, who mentions communication problems as a possible problem. Due to the workload of doctors, there is sometimes too little time to communicate, he emphasizes. "I think this is more of a general problem in medicine than blatantly missing things."

Dr. Paul R. Goddard, a retired radiologist from Bristol, U.K., also thinks the suspended radiologists' error rate appears relatively good. "When I analyzed error rates in radiology, they varied from between 2% for the easiest examinations (head CT) to 35% (MRI abdomen) and this was typical. Usually, half the errors were nonserious and half changed management and were therefore significant. Unless the examinations are double reported, that is the sort of error rate one would expect," he pointed out in a comment posted on AuntMinnieEurope.com on 8 June.

Toxic work culture?

Another source told AuntMinnieEurope.com that other factors played a role in the decision by ZNA Cadix. "There is more to this than meets the eye, much more," the source said. "It is a snake pit. These seven radiologists made errors -- everyone makes errors -- but they were the sacrificial lambs, the offerings, in a big Game of Thrones with political and financial ramifications."

The ZNA network of several hospitals employs over 50 radiologists. It is a highly political outfit managed by those with little or no knowledge about healthcare, and the work environment has deteriorated dramatically in the past 10 years under the leadership of politicians, according to the source. "Doctors are disempowered, are treated as 'workers,' and are not allowed to take pride or assume ownership of their environments and equipment."

Meanwhile, the Standaard newspaper has interviewed one of the suspended radiologists. "The workload was too high. There were too few staff. That certainly played a role," the radiologist said, noting that some members of the team have been together for a long time and have 25 years' experience or more. "Of course, a doctor makes mistakes. Making mistakes happens everywhere in the world. If everyone who makes a mistake is no longer allowed to work, then no one will work anymore."

The radiologist finds it strange that the whole team was suspended at the same time. "It's bad for us, but also for the patients who read this news and get scared."

Among the various rumors now circulating in Belgium is that some directors/managers of ZNA Cadix may have referred patients for scans to Mediport, a nearby private diagnostic facility. Another possibility is the 2024 merger between the ZNA and Gasthuiszusters van Antwerpen (GZA, see https://www.zna.be/nl/over-zna/netwerk-gza-zna) has had an impact on the quality of the radiology services at ZNA Cadix. The mentioned case histories of "broken thumb" and "wrongly measured tumor" may be the tip of the iceberg and the reality could be much worse, and there is little or no post- and in-service radiology training, a source told AuntMinnieEurope.com.

The patient's perspective

National broadcaster VRT broke the news of the suspensions on 7 June. In a second article posted on the same day, a patient gave his account of the misdiagnosis. Aman, who lives in Stabroek, said he had a nasty fall at home in September 2023 and was taken to ZNA Cadix. He had pain in both shoulders and had a scan. The doctors at ZNA Cadix sent him home in a sling and said his shoulder was dislocated.

When the pain persisted, Aman contacted his GP, who referred him to a second radiologist. Another scan revealed a broken collarbone. "They apparently took a scan of the wrong area, so that fracture never appeared," he told VRT. "I actually thought, to err is human. Since I eventually got the correct diagnosis, I tried to put everything into perspective."

Aman said he is now considering asking for more information about his case, just like over 50 other patients who have reportedly contacted the hospital helpline. He does not plan to file a complaint or demand compensation, but he does want to have more clarity.

The Belgian Society of Radiology is now preparing a statement on recent events in Antwerp, De Specialist reported. Also, a second audit of 90,000 scans conducted by radiology departments at three ZNA hospitals is being undertaken by two independent specialists.

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