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Radiologists, Mammograms, and the Threat of Lawsuits

The Risk of Negligence Claims is Real, but Overestimated
Breast imaging is one of the most taxing segments in the field of radiology, because every mammogram is unique. Some breast tumors are impossible to spot. A white malignant mass does not exactly "jump out- in a backdrop of white tissue the way, say, a fracture shouts out on an X-ray.
But failure to detect breast cancer is the number one cause of medical malpractice lawsuits. This means fewer radiology students are interested in the specialty, and it means some radiologists flat-out refuse to read mammograms. Why put yourself in that kind of jeopardy, after years of medical school, residency training, and a fellowship in radiology? Why not stick to reading X-rays or ultrasounds?
According to a study by Joann Elmore, MD, at the University of Washington School of Public Health and Community Medicine in Seattle, radiologists overestimate the risk of lawsuit to be four times more than the actual risk. This equates to one out of three radiologists believing that they will be sued within five years over a mammogram; in truth, only one out of ten radiologists receives a malpractice claim connected to mammography over a five year span.
"Over-diagnosis- Occurs to Ward off Malpractice Suits
Most radiologists confess that they interpret mammograms differently than they would if they weren"t so worried about being sued. Per the US Agency for Healthcare Research and Quality, more than 50 percent of surveyed radiologists are so apprehensive that they are recommending diagnostic mammograms, biopsies, and ultrasounds more than they would in a less litigious environment.  It is the rare radiologist who doesn"t express malpractice anxiety or the tendency to over-diagnose.
How to Fix This Mess?
First, women need to be taught that mammograms are not foolproof screening devices. Women believe that a clear mammogram means they don"t have cancer, but sometimes it"s invisible. If a radiologist is staying on top of the game by accruing continuing education credits, he or she is doing everything right.
Secondly, radiologists can ease some of their apprehension by knowing there are smart attorneys able to defend them. If a case doesn"t settle and it goes to jury trial, more than 80 percent of the time the jury decides in favor of the radiologist. (The vast majority of malpractice suits settle out of court, with or without a payout.) Juries recognize that gross negligence is rare. Though doing mammography work long enough means there is a good chance of a malpractice suit, radiologists need to adopt a "whatever will be, will be- attitude so as not to give up on a desperately needed specialty.
John F. Dick, III, Thomas H. Gallagher, R. James Brenner, Joyce P. Yi, Lisa M. Reisch, Linn
Abraham, Diana L. Miglioretti, Patricia A. Carney, Gary R. Cutter, and Joann G. Elmore. Predictors of Radiologists' Perceived Risk of Malpractice Lawsuits in Breast Imaging. Am. J. Roentgenology, Feb 2009; 192: 327 - 333.

By Michelle Simmons
Get Radiology Jobs, Contributing Editor

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