Radiology: Radiologists reluctant to disclose mammo errors to patients
Thomas H. Gallagher, MD, from the departments of medicine and bioethics & humanities at the University of Washington in Seattle and colleagues conducted an institutional review board-approved survey of 364 radiologists at seven geographically distinct sites of the Breast Cancer Surveillance Consortium, which interpreted mammograms between 2005 and 2006.
According to the authors, a failure to diagnose or a delay in diagnosis of breast cancer are the most common causes of medical malpractice litigation. Consequently, “fear of litigation may also inhibit physicians from communicating more openly with patients about adverse events and errors in radiology,” the authors wrote.
The radiologists were given a hypothetical case in which comparison screening mammograms were placed in the wrong order so that a radiologist reading the mammograms would conclude calcifications were decreasing in number when they were actually decreasing, resulting in a diagnosis delay. The radiologists were asked:
- How likely they would be to disclose this error;
- What information they would share; and
- What were there malpractice attitudes and experiences.
When asked how likely they would be to disclose the (hypothetical) mammography error to the patient, 9 percent said they would “definitely not" disclose the error, 51 percent said "only if asked by the patient," 26 percent said they would “probably” disclose the error and 14 percent said they would “definitely” disclose the error.
When asked what approximate language would be used to inform the patient about the error once they alerted the patient that the diagnostic workup was suspicious for cancer:
- 24 percent would “not say anything further to the patient.”
- 31percent would tell the patient “the calcifications are larger and now are suspicious for cancer.”
- 30 percent would state “the calcifications may have increased on your last mammogram, but their appearance was not as worrisome as they are now.”
- And 15 perent would tell the patient “an error occurred during the interpretation of your last mammogram, and the calcifications had actually increased in number, not decreased.”
Regarding malpractice, 74 percent of survey respondents said they were concerned with the effect medical malpractice has on the practice of mammography. Forty-nine percent had been previously sued for malpractice, while 14 percent had been named in a suit that related to mammography.
According to the authors, a physician’s reluctance to disclose medical errors to a patient could transcend concerns with self-protection. In previous research, for example, physicians have expressed concerns that disclosure of errors could cause a degree of stress in patients that could outweigh the benefits of the disclosure. Another barrier to disclosure, the authors said, could be a physician’s lack of confidence in their communication skills.
Study limitations included the fact that it was based on a single hypothetical exercise to measure the respondents’ attitudes about error disclosure. The authors also pointed out that the respondents could behave differently if faced with the same error disclosure dilemma in real life. The respondents could also have been unwilling to accept that an “error” had occurred without actually reviewing images.
The authors concluded that while there is movement among physicians towards greater openness with patients following errors, “effective disclosure remains the exception, not the rule.” Understanding radiologists’ attitudes towards disclosure, and helping them communicate more effectively with patients following errors, could help improve the patient-physician relationship when it comes to breast imaging, they said.