A new study finds that diagnosis errors—particularly for breast cancer—are the leading cause of malpractice suits filed against radiologists. This goes against the conventional wisdom that most suits resulted from communication errors or failure to recommend additional tests, according to a report in Radiology
, the journal of the Radiological Society of North America.
Researchers from the radiology department at the University of Medicine and Dentistry of New Jersey, Newark, analyzed 4,793 claims self-reported by 2,680 radiologists as part of the credentialing process for One Call Medical, a diagnostic-imaging services provider for workers compensation and auto insurance companies. According to the study, 8,401 radiologists in 47 states—or 24.5% of the radiologist workforce—had contracted with the Parsippany, N.J.-based company. (One author, Dr. Stephen Baker, radiology chairman at University Hospital, Newark, is on the One Call radiology advisory board.
was the reason for 14.83 claims per 1,000 “person years,” the report said, followed by procedural complications, 1.76 claims; and negligence, 1.26. (“Person years” refers to the sum of the number of years the radiologists in the panel have been in practice.)
Breast cancer was the leading cause of diagnosis failure claims, with 3.57 claims per 1,000 person years; followed by nonspinal fractures, 2.49 claims; spinal fractures, 1.32 claims; and lung cancer, 1.26.
For the radiologists studied, malpractice cases peaked between 1996 and 2000, when 1,237 claims (including 841 for failure to diagnosis) were filed. For the 2006-10 period, total claims dropped almost 81% to 238, while failure to diagnose claims dropped more than 86% to 116.
The researchers note that the findings of a 1985 report, in which communication errors were a factor in 80% of malpractice claims against any type of physician, continue to weigh on radiologists' minds. That preoccupation with communication errors is unfounded, the authors wrote. They noted that they were only cited as a factor in 0.71 claims per 1,000 person years. Failure to order additional tests was cited in even fewer claims, only 0.41.
“The conventional wisdom is, 'If I don't suggest additional studies, I will be sued,' ” the authors wrote. “This notion of course contributes to the actual overutilization of imaging studies, or at least to the perception of their overutilization.”
In an interview, Baker said that “failure to communicate”—especially with patients—is a reason for other physicians to be sued and this has been popularly extrapolated to include all physicians.
“Most other physicians talk to their patients—radiologists don't,” Baker said, so this common malpractice trigger “doesn't pertain much to radiologists.”
Baker added that previous studies looking into the causes of radiologist malpractice claims analyzed fewer than 500 cases and relied on physician testimony.
“We think we got more numbers and our numbers had more validity,” he said.
In addressing how their study debunked “the very convenient notion” that radiologists are often sued for not ordering more tests, Baker noted how ordering more tests also happens to generate more work—and thus more income—for radiologists.
“That's a very convenient reason for ordering more tests—but a very minor reason for being sued for malpractice,” Baker said.
The authors also noted that radiologists make up only 3.6% of the U.S. physician workforce, but are the sixth-most sued among all specialties based on number of closed claims in which they have been a defendant. Only obstetricians/gynecologists, internists, family physicians, general surgeons and orthopedists were sued more often—even though, except for orthopedists, physicians in those specialties tend to have more patients than radiologists.
In a related study in the same issue of Radiology
, the same researchers used One Call data and information from the National Practitioners Data Bank
to track the demography of radiologists' malpractice suits.
They found that malpractice awards varied widely. The median payout in Maine was $350,000 compared to $24,105 for Colorado. Average payments ranged from $715,707 in Oregon, to $74,373 in Nebraska. Radiologists in Alabama were the least likely to be sued, those in New York were most likely.