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Lessons Learned From Mammography Medical Malpractice Cases

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Most radiologists in the U.S. read mammograms, and many of us fear being sued in a medical malpractice case during our daily work. Some literature reports that up to 50% of physicians will be sued during their career, similar to the probability of a coin flip. I was sued over a decade ago, and I understand the challenges of navigating a lawsuit at the beginning of my career, with young kids at home, financial obligations, and the fear of a premature end to what I had hoped would be a life-long successful clinical career. 

Fortunately, my case was resolved. I’ll share some of the insights I’ve learned from the medicolegal process as both a defendant and an expert witness, having served in nearly 200 medical malpractice cases, 100 of which involved breast imaging.

Most of us read mammograms as we were taught to do in radiology training, and hope that we won’t get sued if we read them “correctly.” If you only focus on imaging features like spiculated margins and irregular shape, you’re missing the bigger picture. But managing risk starts even before the patient walks in the door of your imaging facility. When you know how and why patients file lawsuits, you can approach your entire workflow and interpretation strategy from a new perspective. 

By considering issues beyond just the imaging, you can reduce malpractice risk and help prepare in case you are sued. And, you can be confident and calm even in what feels like an increasingly risky medical environment. By facing risk head-on instead of hoping you don’t get sued, you are in a position of control that helps everyone: you, your practice, your family, and your patients.

Mammography and Malpractice by the Numbers

Radiologists overestimate the risk of being sued. This leads to fear, which can cloud clinical judgment and increase stress. The oft-quoted “50% chance” of being sued applies to radiologists over a long/lifetime career, and not everyone has the same risk. Women may be sued less often than men, and lawsuits are more common in some states than others. Also, some radiologists may be sued more than once, which can skew statistics further.

Breast Density and the Court of Public Opinion

The breast density movement, resulting in state and federal laws that require radiologists to report breast density (and occasionally recommend additional testing), isn’t the first time patients have advocated for changes to medical care. Physicians and patients are in a great position to work together for better care, but understanding the 100-plus year history of patient activism can help us see the importance of the media in communicating patient-led messages. Breast density can factor into medical malpractice cases, but understanding the dynamic can help us more clearly communicate the true risk to patients.

Exam Order and Referral Processes

You can improve and streamline your facility’s referral process to provide better clinical information and aid exam interpretation while reducing risk. Radiologists can improve the quality and quantity of referrals through better communication throughout the process from clinical order to exam performance.

Exam Protocols and Workflow

During a medical malpractice suit, it is not uncommon to examine a facility’s imaging exam protocols and workflow, whether at a single facility or across different imaging sites. A consistent approach can improve care for patients and strengthen your responses under scrutiny. Some facilities offer cutting-edge and developing technology or controversial imaging such as thermography, which can present additional challenges.

Procedure Protocols and Workflow

Many facilities provide procedures, including biopsy, needle localization, and aspiration.  Potential pitfalls in procedure performance and reporting could affect liability, including radiology-pathology correlation and results communication.

Communicating Results to Patients and Physicians

The Mammography Quality Standards Act is a federal law administered by the FDA and dictates many key patient communication requirements. Failing to follow these mandates and recommendations can lead to lawsuits regarding alleged failure to notify patients and physicians of results by radiologists.

Exam Reports

Radiologists may hold leadership positions at breast imaging centers, including serving as a medical director or a lead and audit interpreting physician, and there may be potential liability associated with specific requirements of those positions. Use of language in the American College of Radiology Breast Imaging and Data Reporting System may also be an important component of clear and consistent communication for letters to patients and reports to clinicians.

Lessons From Real-World Cases

It’s much easier to learn from others’ mistakes to reduce the chance of making your own. In my role as an expert witness, I have learned how different breast density patterns may confer different levels of malpractice risk, why the patients most compliant with yearly screening mammography may be most prone to sue, and the potential pitfalls of palpable mass management. 

What to Do if You Are Sued

It isn’t easy. But it is possible to be your best advocate, take the opportunity to learn, and be an even better doctor after a lawsuit. It is important to work proactively with your defense attorney, and to carefully manage communications about the case. You can grow from a position of strength, not fear, and continue your career better than before.

Key Takeaway Points

Often, plaintiff attorneys tell me their patient client was told by a physician that a previous physician missed something earlier in their care. We cannot know what future exams will show, therefore it is important to approach cases objectively just as I do as an expert witness, reading them prospectively (from earliest to latest) instead of backward (from most recent to least recent). 

I often see malpractice cases involving finger-pointing between different physicians involved in the care of complex patients. Not only does it usually backfire legally, it’s not how we provide the best care as physicians working together.

How can radiologists best avoid medical malpractice cases? Share your thoughts in the comment section.

Gretchen Green, MD, MMS is a radiologist turned expert-educator-explorer who has taught hundreds of physicians and other clinicians how to launch expert witness businesses. She also teaches radiologists to reduce their mammography malpractice risk and improve clarity and confidence. In addition to practicing in North Carolina, she travels around the world, including to the North Pole, and serves as chair of the Space Camp Alumni Board.

Author disclaimer: Not legal, professional, tax, financial, medical, or psychological advice. Consult with licensed professionals regarding your individual circumstances.

Illustration by Jennifer Bogartz

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