Screening versus diagnostic mammography

A survey conducted by the Physician Insurers Association of America found that the most rapidly increasing-and now the leading-cause of malpractice lawsuits filed against radiologists and all physicians is the allegation of a delay in the diagnosis of breast cancer and that among all malpractice lawsuits involving breast cancer filed against physicians, radiologists are now the most frequently named defendants. Furthermore, although an error in diagnosis was recorded in 62% of the cases, the survey also found that communication failures occurred in 71% of the cases. This same survey also emphasized the importance of having a comprehensive patient history available for the radiologist before a patient undergoes mammography. The risk management pointers that follow will help radiologists minimize the likelihood of incurring a medical malpractice lawsuit, maximize the chance for a successful defense if such a suit is filed, and ensure good patient care. Radiologists should have a system in place that ensures that every patient presenting for mammography provides the radiologist with information regarding the patient's medical history, possible symptoms, and clinical signs and that such information be provided by either the patient or the referring physician. Radiologists should make every effort to apprise themselves of all pertinent clinical information relevant to the patient before rendering interpretation of a mammogram. Effective communication between the radiologist, the patient, and the referring physician is essential. All mammographic studies should be defined as screening or as diagnostic and problem-solving breast evaluations. Diagnostic studies require on-site monitoring by a radiologist to effect proper tailoring of the examination. When such monitoring is not feasible and an incomplete evaluation has occurred, the patient should be recalled for additional evaluation with the radiologist present. Once a policy that determines whether a patient undergoes a diagnostic or a screening mammogram is in place, radiologists should not deviate from that policy. For example, if the radiology facility requires that radiologists review questionnaires completed by patients before interpreting a mammogram, the radiologist should not render such an interpretation without first reviewing such a questionnaire. If the questionnaire is missing, the radiologist should request that the patient complete another one.