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EMBARGOED FOR RELEASE ON JUNE 21, 2000
Guidelines Offered to Help Radiologists Avoid Malpractice Suits
Friday, June 16, 2000, Leesburg, VA--Radiologists should clearly state in their mission statements that "productivity is a far less important factor in the determination of income (of radiologists) than "optimal care," says Dr. Leonard Berlin, a well-known expert in malpractice issues in radiology. In an article appearing in the July 2000 issue of the American Journal of Roentgenology (AJR), Berlin recommends a risk management approach to avoid lawsuits.
He cites an unusual malpractice suit against a radiologist filed by a 54-year-old woman whose mammograms showed a cancerous breast lesion missed by the same radiologist in a screening one year earlier, a case that claims the doctor missed the diagnosis because he had read too many radiographs in one day and was "overworked." In the lawsuit, the plaintiff alleged that the radiologist missed the diagnosis on the earlier mammogram because he had read 162 radiographs on that day, more than the average of 50--70 per day cited in published studies. The plaintiff's lawyer petitioned the court for punitive damages alleging that reading so many X rays in a day demonstrated "a wanton disregard of patient well-being by sacrificing quality patient care for volume in order to maximize revenue."
The radiologist himself discovered his error after comparing the newer images to those taken the year earlier. He saw that the front part of the lesion had shown previously in one view but not in the craniocaudal view because the breast had not been properly positioned. He included in his report after the second year's screening that the lesion had been present the year before, although not reported at that time, and recommended the patient undergo a prompt biopsy. The woman underwent a mastectomy as a result and eight months later filed the lawsuit.
Berlin writes, "Risk management in radiology practice can lessen the likelihood of incurring a medical malpractice lawsuit, maximize the chances for a successful defense if a suit is filed, and at the same time enhance patient care." Berlin presents several recommendations to radiologists to improve their performance.
1. Radiologists should be aware of published studies that show the average workload for a radiologist to be 50--70 diagnostic procedures a day, while noting these studies contain disclaimers showing that many factors affect daily workloads for radiologists. These factors include type and complexity of the radiologic procedures; external diversions such as consultations with colleagues; any teaching, research and administrative duties a radiologist may have; radiologists' personal work speeds; and the length of their work day.
2. Radiology practices "should consider including in their group or department policy a reference to workload parameters."
3. "To minimize the potential allegation that radiologists are overworked because revenue is placed before patient care," groups or departments should include in their policies or mission statements "a pledge that although a percentage of revenue may be distributed according to productivity, productivity is a far less important factor in the determination of income than the providing of optimal patient care...."
4. Radiology groups should implement a "performance improvement plan" that they can cite as an indication of their excellence in quality radiology care.
5. Radiologists must commit to "nothing less than 100% of their expertise and knowledge when interpreting all radiologic studies."
About this last recommendation, Berlin states, "The last radiologic examination of the day commands the same full attention...as the first of the day," adding that radiologists who become too tired to provide their peak performance should either delay the interpretation or ask a colleague to fill in.
Berlin writes a regular monthly column of commentary for the AJR on malpractice issues in radiology. These articles may be seen online at www.ajronline.org.
The American Journal of Roentgenology is a monthly publication of the American Roentgen Ray Society (ARRS), the first and oldest radiological society in America. Established in 1900, the Society has been a forum for progress in radiology since shortly after the discovery of the X ray and is dedicated to the goal of the advancement of medicine through the science of radiology and its allied sciences. The ARRS headquarters is located at 44211 Slatestone Ct., Leesburg, VA 20176-5109.
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