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 report.