This case is challenging because it represents a potential error on the part of the radiologist who interpreted a previous film—not the doctor who is currently treating the patient. While standards are being developed to help doctors disclose their own errors, guidelines for discussing other doctors’ errors with patients are lacking.

When Hans Castorp, the protagonist in Thomas Mann’s Magic Mountain, receives a miniature X-ray print, he acquires a passport to what Susan Sontag describes as the “kingdom of the ill.” Hans knows he is ill because the X-ray declares it so, and his doctor merely shows him how to see the proof in the picture.

Variations among physicians in diagnosis and X-ray interpretation, the percentages of which have remained essentially unchanged for five decades, raise serious ethical concerns.