VANCOUVER - Radiologists tend to overestimate their vulnerability to malpractice suits; however, it's important that they keep the reality of lawsuits in mind, not only to reduce their exposure, but also to protect patients from negative outcomes, according to a presentation at the American Roentgen Ray Society (ARRS) meeting.
The number of medical malpractice suits filed in the U.S. each year is actually declining, but those that are filed are more severe, said presenters Dr. Richard Daffner and Dr. Leonard Berlin. Daffner is director of the division of emergency, musculoskeletal, and trauma radiology at Allegheny General Hospital; Berlin is a professor of radiology at Rush University and the University of Illinois.
To minimize risk, radiologists must remain vigilant about communicating urgent results and documenting their interpretation process, especially because the public's take on of "standard of care" can be skewed.
"Although the definition of 'standard of care' does not include a correct diagnosis 100% of the time, that's difficult to explain to a jury," Daffner said. "Too often, public perception is that the standard of care [is perfection]."
Not as bad as you think?
Two-thirds of all medical malpractice cases are resolved without any payment to the patient because they're dismissed, withdrawn, or the defendant is found not guilty, according to Berlin. And if the plaintiff does win the case, most settle for the insurance money, despite frightening news headlines that report settlements of millions of dollars.
"Only 1% of cases that go to trial are found in favor of the plaintiff," he said. "Let's say the plaintiff wins the case with a $20 million verdict. The defense might respond by saying, 'Well sure, you've got this verdict, but we only have $1 million of insurance.' A very high percentage of plaintiffs will take that insurance money rather than going through a lengthy appeals process to get the big award."
But even as he offered session attendees some comforting statistics, Berlin emphasized that radiologists must remain vigilant.
"Radiologists may think that just producing their report is enough," he said. "But these days, we can't necessarily escape liability by doing no more than relaying information through regular channels."
Common causes
The most common cause of malpractice suits is the failure to make a diagnosis, according to Berlin -- a switch from 50 years ago, when the main cause of malpractice claims was doctors doing things they shouldn't have. The second most common cause is failure of the radiologist to communicate exam results to the patient and/or the patient's primary care physician.
"In almost 60% of medical malpractice suits that involve radiologists, the referring physician was never informed of urgent findings," he said. "The courts look at where the series of mistakes that resulted in the negative outcome began, so radiologists need to anticipate that their report may not be read, and make sure urgent information is communicated. And if you make a call to the [emergency department] with urgent findings, document that in your report, along with the name of the specific doctor you spoke with."
What factors contribute to a malpractice lawsuit? A physician-patient relationship, an adverse outcome, an alleged breach of standard of care, and proximate cause -- that is, a direct connection between negligent behavior and what happened to the patient, according to Daffner.
Daffner offered four case studies involving musculoskeletal injuries that resulted in medical malpractice suits, and he analyzed where the mistakes had occurred. He then offered session attendees a few tips:
- Always look at the scout view. Use all available resources to make your diagnosis.
- Once you decide to do an image, do the appropriate study. If the patient really needs a CT, don't order a lesser test.
- Once you decide to image, be thorough.
Medical malpractice litigation doesn't stem from a single error, but rather from a cascade of errors, Daffner cautioned.
"Malpractice suits result from a number of contributing factors, such as failing to perform the correct study, failing to look at the whole image, and failing to communicate results," he said.
