Radiologists overestimate mammography malpractice risk

The perceived threat of medical malpractice claims makes a bigger impression on radiologists than the actual risk of litigation warrants.

Dr. John F. Dick III, an internist in the department of medicine at Dartmouth Medical School in Hanover, NH, and colleagues identified that misconception among other radiologist opinions about medical malpractice risk in an article appearing in the February issue of the American Journal of Roentgenology (2009;192:327-333).

Surveys forming the basis of their report were mailed in 2006 to 118 radiologists who participated in any one of three registries associated with the Breast Cancer Surveillance Consortium in Colorado, New Hampshire, and western Washington. The response rate was 71%. Findings were compared with results from a 2002 mail survey that went to 181 radiologists and generated a 77% response rate (139/181).

On average, radiologists estimated in the 2006 survey that they had a 35% chance of facing a mammography-related malpractice suit in the next five years. The responses were somewhat more pessimistic in 2002, when they rated the likelihood at 41%.

But other survey data suggest the radiologists' perceived threat about possible litigation does not match their actual legal experience. In 2006, 10% of radiologists reported that they had faced a malpractice claim related to mammography in the previous five years. The 2002 survey found that 8% had been sued in the previous five years.

The researchers also found that radiologists who reported a higher perceived risk were more likely to have had a prior malpractice claim, know a colleague with a claim, and tended to be more anxious about uncertainty in clinical situations.

The average perceived risk of being sued is four times higher than the reported rate of malpractice claims, according to the researchers. They found only a 10% risk of actually being sued during their follow-up study in 2006.

The major difference between radiologists who reported a high perceived risk of being sued was that they also scored higher on a scale measuring anxiety.

"I think the results are most instructive because they show risk isn't bad," Dick said in an interview.

He hopes that circulating the numbers in the public about actual risk of being sued will alleviate some stress among radiologists.

Along with circulating those numbers, more education about malpractice risk is needed, according to Dr. Leonard Berlin, chair of radiology at Rush North Shore Medical Center in Skokie, IL.

"There's a difference between perception and reality. And some people say perception is reality," he said.

As a product that had, in a way, to be sold to the public to persuade at-risk women to undergo routine screening, mammography was oversold, he said.

"If the woman believes, ‘I had a mammogram, they found my cancer, I got my cancer taken out, I got cured, therefore the mammogram saved my life,' then what's the reverse? The reverse is, ‘I had a mammogram, they missed my cancer, therefore the miss, the radiologist, cost me my life,'" he said.

When women believe mammography is so life-saving, they are more apt to sue if a radiologist misses something, which is why malpractice litigation rates regarding mammography are so high, Berlin said.

There is also another piece to the puzzle.

Since the two most common radiology exams are chest films and mammograms, if radiologists make the same error rate in everything they do, there will be more errors in chest film and in mammograms because radiologists do more of them, he said.

Both patients and physicians need more education in order to combat the malpractice environment, Berlin said. He expects the gap between perception and reality to close with more education about medical malpractice.

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