RSNA: Radiology full of malpractice minefields

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CHICAGO--Radiologists who are caring, competent, comprehensive, consistent and credible should be able to practice their livelihood without too much fear of being sued for malpractice, according to a presentation "Minefields in Radiology," delivered Thursday at the Radiological Society of North American (RSNA) conference.

Robert Albert Schmidt, a radiologist at the University of Chicago Medical Center, referred to a quote from Walt Kelly’s famous comic strip “Pogo” to describe the situation radiologists sometimes find themselves in when it comes malpractice—“We have met the enemy and them is us.”

For example, Schmidt pointed out that few radiologists have read the American College of Radiology standards. “So if you don’t know what’s there, guess who reads these things,” he said. “Lawyers—lawyers read these things all the time. So you may think, ‘I don’t agree with this, this isn’t the way I practice.’ But the fact is you need to know what’s going on there because you’re vulnerable to it. They read it.”

The failure of radiologists to take steps like this to protect themselves from malpractice suits occurs despite the fact a large percentage of these radiologists believe they are extremely vulnerable to these suits.

For example, surveys taken in 2002 and 2006 found that radiologists' mean estimate of the probability of being sued for malpractice in the next five years was 41 percent in 2002 and 35 percent in 2006. The actual number of claims was 8 percent in 2002 and 10 percent in 2006, which means, Schmidt said, that the fear of being sued for malpractice is exaggerated.

Yet, radiology remains the speciality most likely to be sued. According to figures supplied by Schmidt, the specialty represented 11 percent of the malpractice cases in 1990, 24 percent in 1995 and 33 percent in 2002.

Why are lawsuits rising? Schmidt -- who was speaking specifically about mammography malpractice during his part of the presentation -- says that one of the problems is that the public has unrealistic expectations, “some of which we’ve actually fostered by our own promotion of mammograms. It’s a two-edged sword. We want people to have mammograms and we promote them. But on the other hand, they’re not perfect.” Schmidt added that factors such as pressures to cut costs and the larger volumes of cases being handled are also reason for the increase in malpractice suits.

Many of these cases involve symptomatic patients with palpable lesions or some other complaint, said Schmidt. But one of the major problems in many of these situations, he said, was a failure to do an ultrasound. “The biggest thing I can tell you is that if you have a person with a complaint, do an ultrasound.”

One-third of plaintiffs in mammography malpractice cases are under the age of 40, said Schmidt, and the median age of a claimant is 44. In addition, patients in 59 percent of these cases found lesions. So a typical profile of a patient suing is someone who is “young and has a complaint,” said Schmidt.

To protect their patients and to protect themselves against lawsuits, Schmidt said radiologists should always:

  • Follow up with other consultants;
  • Recommend a tissue diagnosis if a patient has a palpable mass with a negative breast image evaluatio;
  • Reinterpret a technically poor mammogram;
  • Recommend another mammogram with added views or other imaging as appropriate if the original mammogram is equivocal;
  • Be sure everything is accurately performed and documented;
  • Compare to previous studies;
  • Report results promptly;
  • Tell a patient  to consult with her primary physician if there is an abnormal result;