Mammography screening for breast cancer has advanced rapidly, helping lower mortality rates by nearly 40% since its widespread adoption. Medical malpractice fears have unfortunately increased in the process.
More than 60% of radiologists interpret breast imaging studies, according to figures published Dec. 11 in Clinical Imaging. And paired with the fact that there is a nearly 50% chance a radiologist will be tangled up in a malpractice claim by the time they turn 60, many are thinking twice before interpreting breast imaging exams.
“Given a charged medicolegal climate, the high prevalence of breast cancer, the widespread public awareness of screening mammography, and confusion of lay people regarding the role and efficacy of screening mammography, a delay in breast cancer diagnosis is one of the most prevalent and expensive concerns resulting in malpractice lawsuits,” Michelle V. Lee, with Washington University’s Mallinckrodt Institute of Radiology in St. Louis, and colleagues wrote.
In an effort to better understand the factors contributing to this environment, Lee et al. analyzed 253 cases of breast cancer-related malpractice in the U.S. from 2005 to 2015.
Below are 6 takeaways from their work:
1. Patients often have unrealistic expectations
The general population’s expectations of screening mammography are often “unrealistic,” the authors wrote. Some even believe the modality prevents breast cancer.
Lee and colleagues found that, according to one survey, nearly half of women believe breast cancer that doesn’t show up on screening mammography entitles them to a malpractice payout.
2. Delay in diagnosis commonly leads to lawsuits
Looking at the overall landscape, most cases resulted in a verdict favoring the physician (45%), with another 26% favoring the patient and 29% resulting in a settlement.
A delay in diagnosis was the primary cause for litigation, comprising 82% of cases. A delay of 12 months or more was two-fold more likely to end with payment compared to a delay of less than one year.
Failure to refer a patient to a surgeon was also two-fold more likely to conclude with payment. However, in the 12% of cases which found the patient did not adhere to follow-up recommendations, there was a two-fold lower likelihood for a malpractice award.
Given these figures, the researchers suggest that consistent documentation could offer protection for physicians.
3. Radiologists and surgeons frequently named defendants
Most cases cited radiologists as defendants (43%), followed by surgeons (27%), obstetrician/gynecologists (26%) and internal medicine/family practice physicians (15%). Prior studies, the researchers noted, have found that gynecologists were sued most often.
The change may stem from a “paradigm shift” in the way cancer is diagnosed, moving from a primary physician to a more multidisciplinary, team-based approach, the researchers wrote.
4. Patients are younger
The median age of plaintiffs was 46 years old, younger than the median age of breast cancer diagnosis for all U.S. women.
The results align with other studies that suggest malpractice claims related to breast cancer are more likely in those under 50 years old. Lee et al. said this may be because younger patients face a “worse prognosis” related to morbidity and mortality, while older patients have fewer financial resources to pay attorneys.
5. Large payouts are common
Multi-million dollar payouts were common, with the average plaintiff payment coming in at $978,858 ± 2,308,598.
In cases that reached a verdict, the median amount awarded to the plaintiff (patient) was $862,500. For comparison, cases that were settled payed out a median of $1,162,500.
6. Malpractice and tort reform varies geographically
Many of those who receive malpractice compensation often have taken advantage of the system, the authors wrote. More than 30 states have put caps on damages to address this, including Texas.
Since the Lone Star state enacted comprehensive tort reform in 2003, it has seen an influx of physicians per capita and fewer malpractice suits with lower monetary payouts. State-by-state policy still varies, and malpractice and tort reform remains a “highly politicized topic."
Looking ahead, Lee and colleagues believe their study may improve aspects of healthcare beyond just medical malpractice.
“Better understanding of factors and trends in malpractice litigation can lead to improvements in patient care, safety and satisfaction as well as betterment of the malpractice system,” the team concluded. “More productive interactions between the medical and legal systems regarding malpractice data accessibility should be an area of future collaboration.”