Automated screening of Pap smears provides
greater accuracy than traditional manual readings, as discussed in
part 2 of this article . As this technology comes into greater use,
the standard of care regarding Pap smears may shift, such that a
physicians failure to recommend automated screening could be
held against him in a malpractice lawsuit.
Use of automated screening, however, is only one factor that could
potentially reduce a physicians risk of being sued successfully
for malpractice. By following the recommendations listed below,
physicians can further protect themselves from malpractice claims
resulting from inaccurate Pap smear results.
Recommend annual screening. Recommend annual Pap smears to
your patients, especially if they fall into one of the at-risk
groups. If the patients insurer only covers Pap smears once
every 2 or 3 years, you should still recommend annual screening and
inform patients that they might have to pay for the test themselves.
That way, the patient can decide for herself whether she wants the
Educate the patient. Educate your patients about
false-negative Pap smears and why they occur. Prior to performing a
Pap smear, you may want to have the patient sign a document that
states that she has been informed about the potential for Pap smear
errors and understands that the test, while an indicator for
precancerous or cancerous conditions, is not a guarantee that the
patient is free of cancer.
Avoid medical jargon as much as possible when preparing such a
document and when communicating to your patients. The legal standard
is usually based on what a reasonable person can understand.
Investigate the laboratories. If you are in private practice,
investigate the laboratories you use to determine their accuracy rate
for Pap smears. Inquire about the number of slides each
cytotech-nologist reviews on a daily basis, the experience of the
staff, and the quality control methods employed. Most laboratories
will welcome the chance to present their qualifications and
experience to an interested physician. Talk to your peers about the
laboratories they use and any potential problems they might have had.
If you are part of a managed care or provider network that contracts
out to a particular laboratory, talk with the director of medical
services to find out what factors were considered when selecting a laboratory.
Determine which labs in your network (if any) use automated
screening, either for primary screening or as quality control. Find
out if the technology is used on all slides or only on request.
Inform the patient of screening options. If your
laboratory does not use automated screening, you should still inform
your patients that automated screening methods are available. Tell
them about the potential benefits and drawbacks, including the fact
that automated screening is more expensive than traditional Pap smear
screening, and that the patient may have to bear the additional cost.
Too often physicians assume that a patient is not willing to pay more
for enhanced care. It is neither your position nor in your best
interest to decide what a patient can or cannot afford. If a patient
chooses not to use enhanced screening and then has one or more
false-negative results, it will be very hard to argue medical
negligence, since the patient was fully informed of her options.
Document results. Document Pap smear results and all
information provided to the patient. Many physicians only contact
patients if there is an abnormal Pap smear. It is in your best
interest to send a letter to all your patients informing them of
their Pap smear results. Document the date that the letter was sent.
In addition, document all information that you have provided to the
patient regarding Pap smears and cervical cancer during her office
visits. Some physicians even record patient follow-up calls.
Best Line of Defense
Keep in mind that these are simply recommended guidelines. If you are
concerned about whether you or your practice is at risk, consult with
an experienced malpractice attorney who can offer you more
There is little doubt that most physicians today spend far more time
on record keeping and paperwork than physicians did 20, or even 10,
years ago. While some physicians may find following the above
guidelines an imposition, such thoroughness could prove to be the
best line of defense in the event that a malpractice claim is filed.
No matter how experienced and conscientious physicians are, medicine
is not a perfect science. Unintentional errors or misdiagnoses do
occasionally occur, and in most cases the error is caught and the
patient treated without any negative effects. However, even one
malpractice claim against a physician or his/her practice can have a
Physicians who provide obstetric and gynecologic care tend to be in
the higher risk categories when it comes to malpractice claims,
especially regarding Pap smear litigation. Many factors, including
the subjectivity involved in diagnosing difficult cases and sampling
problems with specimen collection, prevent zero-error performance.
Yet new technologies such as automated screening have been clinically
proven to significantly reduce the rate of false-negative results.
Incorporating the recommendations presented in this article into
current practice should go a long way toward protecting a physician
from malpractice suits.