A radiologist interprets a photo and sees a tumour. When checking the images from the same patient a year before, he sees it on those images as well. In hindsight, he could have seen the tumour one year earlier. He does not report this to the patient. Why not?

As it appears, missing a tumour on a photo is not at all unusual. The radiologist literally interprets hundreds of pictures a day which is certainly straining and tiring; a certain error percentage is seen as inevitable. Despite being a clear safety catch, there is in practice no time for comparing pictures with earlier images. Interestingly, radiologists are paid by the number of interpreted images and it is said that it would not be in their (financial) interest to hire more radiologists to ease the burden of work and, more importantly, increase the safety of the interpretation. The percentage of misinterpretations are accepted as part of the job. However, missed diagnoses are not registered in any form of complication registry and are not followed up by analysis of root causes or contributing factors. So nothing is learned from them. Basically, it is seen as inevitable that one misses a diagnosis now and again and most radiologists do not deem it useful to spend time trying to improve this.

We argue this behaviour (as represented here) as an example of a broken rule: everyone in the group of radiologists at this particular hospital is clear about how safety could be improved but feel that would be too much of a penalty in pay and status. Common sense and accepted professionally correct conduct is overruled by personal gain.