ARRS BIS: Sorting fact from fiction in mammography malpractice

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Breast imagers always try to minimize their exposure to medical malpractice -- especially as delayed breast cancer diagnosis is the most common cause. But the real risk of being sued is much lower than most radiologists estimate, according to a talk at this week's American Roentgen Ray Society (ARRS) Breast Imaging Symposium (BIS) in Phoenix.

"There is a medicolegal crisis: jury awards are climbing, and in delayed diagnosis cases, the radiologist is often the No. 1 person to get sued," said Dr. Michael Linver of X-Ray Associates of New Mexico. "But the truth is there's a difference between our conception of the problem and the reality."

Dr. Michael Linver.Dr. Michael Linver.
Dr. Michael Linver.

Mammography is the most thoroughly scrutinized exam in the history of medicine, Linver said. Combine this with the fact that the public has unrealistic expectations about what the test can actually do, and it's a formula for lawsuits. However, even though many radiologists think their chances of being sued are almost 50%, their risk is actually more like 10% -- four times lower than the perceived prevalence, Linver said, citing a commentary by Dr. Leonard Berlin in the American Journal of Roentgenology (February 2009, Vol. 192:2, pp. 334-336).

"We've set the bar pretty high as to mammography's benefits, and the public has bought into it," he said. "Now patients expect breast imagers to be superheroes, able to slay the dragon of breast cancer in whatever form it takes."

What can breast imagers do to mitigate their chances of being named in a malpractice suit? Plenty, according to Linver -- and most of it is common sense. A good place to start is becoming familiar with the statutory elements of the Mammography Quality Standards Act (MQSA) and the American College of Radiology's (ACR) guidelines for breast imaging. Although these are not legally binding, they often become the standard-of-care framework in lawsuits, Linver said.

And, of course, breast imagers must understand any particular county or state health and safety laws that affect the practice of mammography, as well as tort law for negligence.

"Everything we do in breast imaging can be considered cause for negligence," Linver said. "We have an enormous number of duties. So what's really helpful is to keep in mind a manageable list of the key issues to track so as to avoid medical malpractice suits."

Breast imagers should track these common causes of negligence, according to Linver:

  • Not contacting the referring physician regarding urgent or significant findings
  • Reports that fail to suggest abnormalities
  • Errors in diagnosis
  • Failure to follow up appropriately with patients
  • Failure to perform biopsy
  • Poor image quality

Be sure to repeat all technically poor mammograms, recommend additional evaluation as appropriate if the initial mammogram is equivocal, ensure that a physical exam was performed and documented, compare current and previous studies, and report results promptly, Linver advised. Always document everything, he emphasized.

"As you go forward, use common sense," he said. "Talk to your patients, especially the ones who are upset. You want to prevent situations where the patient feels no one cares. It's the angry patients who tend to sue."

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