DALLAS--In the last 5 years, radiologists have become the specialists
most often sued over breast cancer diagnoses, said Cathy R. Bowerman,
JD, MPH, of the Southfield, Michigan, firm of Siemion, Huckabay,
Bodary, Padilla, Morganti, & Bowerman.
A study of 21 companies that insure physicians showed that the
number of claims involving breast cancer diagnosis filed against
ob/gyns fell from 39% of the total in 1990 to 23% in 1995, while
the claims against radiologists rose from 11% to 24%. "Ob/gyns
have gotten better about referring patients for mammo-grams, and
radiologists with their increasing load have become far more at
risk," Ms. Bowerman said at an American College of Radiology
breast cancer meeting.
Radiologists tend to get "sucked into claims" for a
number of reasons (see table on page 19), she said, many of which
are easily preventable. For example, to ensure that abnormal results
are not overlooked, Ms. Bowerman recommends the use of "a
big stamp saying ABNORMAL" to be stamped in red ink across
any report of an abnormal reading. A stamp saying EQUIVOCAL could
also be used.
Another simple preventive measure: Type each x-ray report on a
separate page. Ms. Bowerman described a case in which an abnormal
chest x-ray in the right lung and a normal mammogram were reported
on the same sheet. The nurse who received the report saw at the
bottom of the page "normal bilateral mammogram" and
read no further, missing the chest x-ray results.
The abnormal report was not noticed until months later when the
patient visited her physician for another problem. "Needless
to say it was lung cancer, and the case ended up costing the radiologist's
insurer $200,000," she said.
She urged radiologists to develop some fail-safe method of getting
reports out to physicians and patients and documenting, through
their computer system, when and to whom the report was sent. "I
have had cases where a radiologist called a referring physician
about an abnormal finding but did not document anywhere that he
had made the phone call. When a lawsuit was filed, the physician
did not remember the phone call."
Rule of thumb, she said: If you think enough to pick up the phone
to call a clinician, please think enough to document that in your