1
|
Shabpiray H, George J, Patel S, Khorsand Askari M. Navigating the Pitfalls of Lung Cancer Screening: A Case Study on the Risks and Costs of Negative Screenings. Cureus 2024; 16:e59844. [PMID: 38854349 PMCID: PMC11157477 DOI: 10.7759/cureus.59844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in the United States. Low-dose computed tomography is the preferred screening method for high-risk individuals. However, with a false-negative rate reaching 15%, this method can underestimate disease prevalence and delay necessary treatment. This case examines a 61-year-old female smoker with chronic obstructive pulmonary disease who initially received a negative result from screening. Her imaging findings were categorized as Lung Imaging Reporting and Data System (Lung-RADS) 2 but advanced to small cell lung carcinoma. This progression emphasizes the imperative of thoroughly evaluating screening results and patient history. False-negative results from screenings have profound implications, leading to delayed diagnoses, adversely affecting patient outcomes, and increasing healthcare costs. The necessity for vigilant follow-up enhanced diagnostic precision and transparent communication about limitations is paramount. An economic analysis emphasizes the significant financial impact of diagnosing lung cancer at advanced stages, highlighting the need for timely and accurate diagnostics. Comprehensive strategies, such as physician education, patient awareness, and stringent quality control, are crucial to improving the efficacy of lung cancer screening. Addressing the issue of false negatives is vital for enhancing early detection rates, decreasing healthcare expenses, and advancing patient care in lung cancer management. Continuous evaluation and adjustment of screening protocols are essential to reduce risks and optimize outcomes.
Collapse
Affiliation(s)
- Hoda Shabpiray
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Jerrin George
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Shivani Patel
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Mani Khorsand Askari
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| |
Collapse
|
2
|
Lee CS, Goldman L, Grimm LJ, Liu IX, Simanowith M, Rosenberg R, Zuley M, Moy L. Screening mammographic performance by race and age in the National Mammography Database: 29,479,665 screening mammograms from 13,181,241 women. Breast Cancer Res Treat 2024; 203:599-612. [PMID: 37897646 DOI: 10.1007/s10549-023-07124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/09/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE There are insufficient large-scale studies comparing the performance of screening mammography in women of different races. This study aims to compare the screening performance metrics across racial and age groups in the National Mammography Database (NMD). METHODS All screening mammograms performed between January 1, 2008, and December 31, 2021, in women aged 30-100 years from 746 mammography facilities in 46 U.S. states in the NMD were included. Patients were stratified by 10-year age intervals and 5 racial groups (African American, American Indian, Asian, White, unknown). Incidence of risk factors (breast density, personal history, family history of breast cancer, age), and time since prior exams were compared. Five screening mammography metrics were calculated: recall rate (RR), cancer detection rate (CDR), positive predictive values for recalls (PPV1), biopsy recommended (PPV2) and biopsy performed (PPV3). RESULTS 29,479,655 screening mammograms performed in 13,181,241 women between January 1, 2008, and December 31, 2021, from the NMD were analyzed. The overall mean performance metrics were RR 10.00% (95% CI 9.99-10.02), CDR 4.18/1000 (4.16-4.21), PPV1 4.18% (4.16-4.20), PPV2 25.84% (25.72-25.97), PPV3 25.78% (25.66-25.91). With advancing age, RR significantly decreases, while CDR, PPV1, PPV2, and PPV3 significantly increase. Incidence of personal/family history of breast cancer, breast density, age, prior mammogram availability, and time since prior mammogram were mostly similar across all races. Compared to White women, African American women had significantly higher RR, but lower CDR, PPV1, PPV2 and PPV3. CONCLUSIONS Benefits of screening mammography increase with age, including for women age > 70 and across all races. Screening mammography is effective; with lower RR and higher CDR, PPV2, and PPV3 with advancing age. African American women have poorer outcomes from screening mammography (higher RR and lower CDR), compared to White and all women in the NMD. Racial disparity can be partly explained by higher rate of African American women lost to follow up.
Collapse
Affiliation(s)
- Cindy S Lee
- Department of Radiology, New York University Langone Health, New York, USA.
- Department of Radiology, State University of New York at Stony Brook, Renaissance School of Medicine, Stony Brook, NY, USA.
| | - Lenka Goldman
- American College of Radiology, 1891 Preston Drive, Reston, VA, USA
| | - Lars J Grimm
- Department of Radiology, Duke University, Durham, NC, USA
| | - Ivy Xinyue Liu
- American College of Radiology, 1891 Preston Drive, Reston, VA, USA
| | | | | | - Margarita Zuley
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Linda Moy
- Department of Radiology, New York University Langone Health, New York, USA
| |
Collapse
|
3
|
Doolin JW, Schaffer AC, Tishler RB, Jacobson JO. An analysis of medical malpractice claims against medical oncologists from a national database: Implications for safer practice. J Healthc Risk Manag 2024; 43:18-28. [PMID: 38098175 DOI: 10.1002/jhrm.21563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 12/24/2023]
Abstract
Malpractice claims data include valuable information about patient safety. We used mixed methods to analyze claims against medical oncologists (MO) from 2008 to 2019 using a national database. MO claims were compared to a group of other internal medicine subspecialties (OIMS). Logistic regression was used to examine correlates of closing with an indemnity payment. A subset of claims against MO were thematically analyzed using a validated safety incident taxonomy as a framework. 456 claims against MO were compared with 5771 claims against OIMS. MO claims closed with indemnity payments 29.8% of the time versus OIMS 30.3% (p = 0.87). Median MO and OIMS indemnity payments were similar ($190,591 vs. $233,432; p = 0.20). Correlates of MO claims closing with payment included patient assessment, communication among providers, and safety and security as contributing factors. Thematic analysis identified provider cognitive error, adverse drug events and relational problems as the most common safety incidents. MO malpractice claims have similar outcomes to OIMS. We demonstrate the proof-of-concept of applying a safety incident taxonomy to medical malpractice. Finding ways to reduce patient exposure to provider cognitive errors, adverse drug reactions, and communication breakdowns should be strategic priorities for safer cancer care.
Collapse
Affiliation(s)
- Jim W Doolin
- Lahey Hospital and Medical Center, Hematology/Oncology, Burlington, USA
| | - Adam C Schaffer
- CRICO/Risk Management Foundation of the Harvard Medical Institutions, Brigham and Women's Hospital, Internal Medicine, Boston, USA
| | - Roy B Tishler
- Dana-Farber Cancer Institute, Radiation Oncology, Boston, USA
| | | |
Collapse
|
4
|
Forrest C, Madden D, O'Sullivan MJ, O'Reilly S. Learning From Medical Litigation. JCO Oncol Pract 2023; 19:160-163. [PMID: 36652657 DOI: 10.1200/op.22.00763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Clara Forrest
- Academic Track Intern Programme, Intern Network Executive, School of Medicine, University College, Cork, Ireland
| | | | | | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland.,Cancer Research@UCC, University College Cork, Cork, Ireland
| |
Collapse
|
5
|
Glaucoma-related malpractice litigation in the United States: A review of the WestLaw database. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221139686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose Gaining understanding of glaucoma-related malpractice litigation may highlight ways to improve patient care and minimize risk of litigation. This study aims to analyze the outcomes and characteristics of glaucoma-related malpractice litigation. Materials and Methods The Westlaw legal database (Thomson Reuters, New York, NY, USA) was used to identify cases regarding ‘malpractice’ AND ‘glaucoma’ or related terms. Cases were analyzed for characteristics such as alleged cause of malpractice, outcome, and demographics. Results The initial search terms yielded 498 results, 107 of which met further inclusion criteria. 38 (36%) were resolved via jury trial. Of these, verdicts in favor of the plaintiff were issued in 14 cases (34%), with median adjusted damages of $702,986. Of all 107 cases in the study reviewed, 65 (61%) resulted in verdicts in favor of the defendant. Ophthalmologists were named as defendants in 85% of the cases (with glaucoma specialists representing 7% of the ophthalmologists); optometrists in 24%. Sixty percent of the cases involved non-surgical treatment. The most common medical reasons for litigation were failure to diagnose (38%), and inappropriate/negligent treatment (36%). The most commonly litigated surgical procedures were cataract surgery (48%) and iridotomy/iridectomy (19%). Conclusion Glaucoma-malpractice litigation has increased, with medical mismanagement alleged in the majority of cases. Defendants are frequently successful in obtaining pre-trial dismissal, but the risk of liability increases in cases going to trial. A minority of cases involved glaucoma specialists. This historical analysis of glaucoma-related malpractice cases might provide perspective and aid physicians seeking to avoid litigation.
Collapse
|
6
|
Tharp K, Santavicca S, Hughes DR, Kishore D, Banja JD, Duszak R. Characteristics of Radiologists Serving as Medical Malpractice Expert Witnesses for Defense Versus Plaintiff. J Am Coll Radiol 2022; 19:807-813. [PMID: 35654146 DOI: 10.1016/j.jacr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Previous studies have reported higher qualification characteristics for anesthesiologists, neurosurgeons, orthopedic surgeons, and otolaryngologists serving as defense (versus plaintiff) medical malpractice expert witnesses. We assessed such characteristics for radiologist expert witnesses. METHODS Using the Westlaw legal research database, we identified radiologists serving as experts in all indexed medical malpractice cases between 2010 and 2019. Online databases were used to identify years of practice experience and scholarly bibliometrics. Using Medicare claims, individual radiologist practice types and mixes were ascertained. Radiologists testifying at least once each for defense and plaintiff were excluded from our defense-only versus plaintiff-only comparative analysis. RESULTS Initial Boolean searches yielded 1,042 potential cases; subsequent manual review identified 179 radiologists testifying in 231 lawsuits: 143 testified in one case (58 defense, 85 plaintiff) and 36 testified in multiple cases (10 defense-only, 14 plaintiff-only, 12 both). The 68 defense-only experts had fewer years of practice experience than the 99 plaintiff-only experts (28.3 versus 31.8 years, P = .02), but the two groups were otherwise similar in both practice type (44.6% versus 54.9% academic, P = .62) and mix (63.8% versus 65.8% practiced as subspecialists, P = .37) and as well as numbers of publications (60.5 versus 62.8, P = .86), citations (1,994.1 versus 2,309.2, P = .56), and h-indices (17.2 versus 16.8, P = .89). CONCLUSIONS In contrast to other specialists, radiologists serving as medical malpractice expert witnesses for defense and plaintiff display similar qualifications across various characteristics. Published practice parameter guidelines and experts' ability to blindly review archived original images might together explain this interspecialty discordance.
Collapse
Affiliation(s)
- Kenneth Tharp
- Department of Radiology and Imaging Sciences, Emory University School of Medicine.
| | - Stefan Santavicca
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Danny R Hughes
- Department of Radiology and Imaging Sciences, Emory University School of Medicine; Director of the Health Economics and Analytics Laboratory (HEAL), School of Economics, Georgia Institute of Technology
| | - Divya Kishore
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | | | - Richard Duszak
- Vice Chair of the Department of Radiology and Imaging Sciences, and Director of the Imaging Policy Analytics for Clinical Transformation (IMPACT) Research Center, Department of Radiology and Imaging Sciences, Emory University School of Medicine; ACR Board of Chancellors
| |
Collapse
|
7
|
Phalak KA, Gerlach K, Parikh JR. Peer learning in breast imaging. Clin Imaging 2022; 85:60-63. [PMID: 35247790 DOI: 10.1016/j.clinimag.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022]
Abstract
With the increasing focus on quality and safety in medicine, radiology practices are increasingly transitioning from traditional score-based peer review to peer learning. Participation in a peer learning program can increase learning, practice improvement, and cultivation of interpersonal relationships in a non-punitive environment. As breast imaging errors are the most cited in medical malpractice cases, learning and attention to and reduction of these errors in breast imaging are especially important. We describe the strengths of a peer learning program, implementation process in a breast imaging program, challenges to overcome, and strategies to support success.
Collapse
Affiliation(s)
- Kanchan A Phalak
- Department of Radiology, University MD Anderson Cancer Center, Houston, TX, USA.
| | - Karen Gerlach
- Department of Radiology, University MD Anderson Cancer Center, Houston, TX, USA.
| | - Jay R Parikh
- Department of Radiology, University MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
8
|
Current Trends and Predictors of Case Outcomes for Malpractice in Colonoscopy in the United States. J Clin Gastroenterol 2022; 56:49-54. [PMID: 33337638 DOI: 10.1097/mcg.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/26/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND Over 14 million colonoscopies are performed annually, and this procedure remains the largest contributor to malpractice claims against gastroenterologists. The aim of this study was to evaluate reasons for litigation and predictors of case outcomes. MATERIALS AND METHODS Cases related to colonoscopy were reviewed within the Westlaw legal database. Patient demographics, reasons for litigation, case payouts, and verdicts were assessed. Multivariate regression was used to determine predictors of defendant verdicts. RESULTS A total of 305 cases were included from years 1980 to 2017. Average patient age was 54.9 years (range, 4 to 93) and 52.8% of patients were female. Juries returned defendant and plaintiff verdicts in 51.8% and 25.2% of cases, respectively, and median payout was $995,000. Top reasons for litigation included delay in treatment (65.9%) and diagnosis (65.6%), procedural error (44.3%), and failure to refer (25.6%). Gastroenterologists were defendants in 71% of cases, followed by primary care (32.2%) and surgeons (14.8%). Cases citing informed consent predicted defendant verdict (odds ratio, 4.05; 95% confidence interval, 1.90-9.45) while medication error predicted plaintiff verdict (odds ratio, 0.18; 95% confidence interval, 0.04-0.59). Delay in diagnosis (P=0.060) and failure to refer (P=0.074) trended toward plaintiff verdict but did not reach significance. Most represented states were New York (21.0%), California (13.4%), Pennsylvania (13.1%), Massachusetts (12.5%). CONCLUSIONS Malpractice related to colonoscopy remains a significant and has geographic variability. Errors related to sedation predicted plaintiff verdict and may represent a target to reduce litigation. Primary care physicians and surgeons were frequently cited codefendants, underscoring the significance of interdisciplinary care for colonoscopy.
Collapse
|
9
|
Branach C, Tharp K, Duszak R. Distribution and Characteristics of Malpractice and Nonmalpractice Litigation Involving Interventional Radiologists in the United States from 1983-2018. Curr Probl Diagn Radiol 2021; 50:803-806. [DOI: 10.1067/j.cpradiol.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/23/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022]
|
10
|
Fan B, Pardo J, Yu-Moe CW, Janes M, Falcone B, Valero MG, Serres SK, Emhoff I, James TA. Malpractice Cases in Breast Surgery: An Assessment of Litigation Involving Surgeons. Ann Surg Oncol 2021; 28:8109-8115. [PMID: 34115250 DOI: 10.1245/s10434-021-10236-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Improving patient safety and quality are priorities in health care. The study of malpractice cases provides an opportunity to identify areas for quality improvement. While the issues surrounding malpractice cases in breast cancer are often multifactorial, there are few studies providing insight into malpractice cases specifically related to common breast cancer surgical procedures. We sought to characterize the factors in liability cases involving breast cancer surgery. METHODS Closed cases from 2008 to 2019 involving a breast cancer diagnosis, a primary responsible service of general surgery, surgical oncology, or plastic surgery, and a breast cancer procedure were reviewed using data from the Controlled Risk Insurance Company (CRICO) Strategies Comparative Benchmarking System database, a national repository of professional liability data. RESULTS A total of 174 malpractice cases were reviewed, of which 41 cases were closed with payment. Plastic surgeons were most commonly named (64%, 111/174), followed by general surgeons (30%, 53/174), and surgical oncologists (6%, 10/174). The most common allegation was error in surgical treatment (87%, 152/174), and infection, cosmetic injury, emotional trauma, foreign body, and nosocomial infections represented the top five injury descriptions. On average, indemnity payments were larger for high clinical severity cases. Technical skills, followed by clinical judgment, were the most commonly named contributing factors. The average payment per case was $130,422. CONCLUSION Malpractice cases predominantly involve technical complications related to plastic surgery procedures. Better understanding of the malpractice environment involving surgical procedures performed for breast cancer may provide practical insight to guide initiatives aimed at improving patient outcomes.
Collapse
Affiliation(s)
- Betty Fan
- Department of Surgery, Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jaime Pardo
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02115, USA
| | | | | | | | - Monica G Valero
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02115, USA
| | - Stephanie K Serres
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02115, USA
| | - Isha Emhoff
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02115, USA
| | - Ted A James
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02115, USA.
| |
Collapse
|
11
|
Anteby R, Lillemoe KD, Fernández-Del Castillo C, Ferrone CR, Qadan M. Analysis of in court malpractice litigation following pancreatic surgery. Pancreatology 2021; 21:819-823. [PMID: 33653655 DOI: 10.1016/j.pan.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic operations are technically complex with a significant risk of morbidity and mortality. Analysis of litigation following surgery can disclose avoidable errors. METHODS Two legal databases, Westlaw and Lexis Nexis, were queried for jury verdicts, settlements and appeal cases in the United States related to pancreatic surgery and malpractice between 1980 and 2020. RESULTS Thirty-four cases were analyzed. Pancreaticoduodenectomy (n = 22, 65%) was the most common procedure litigated. Claims most commonly involved malpractice in the postoperative (n = 16) setting. The most common claims were failure to diagnose or treat postoperative complications (n = 16), lack of informed consent (n = 9), and wrongful indication for surgery (n = 8). Seven cases involved incorrect diagnosis of pancreatic cancer. Attending surgeons were the main provider named in the medical malpractice claim in 25 (74%) of the cases. Resident surgeons were named in 5 cases (15%). Half of the cases (n = 17) involved patient deaths. The court ruled in favor of the defendant in 75% of the cases, and the plaintiff in 12.5%. Median payout for settlements and plaintiff verdicts was 783,304 USD (interquartile range (IQR) 1,034,046). Mean time from incident to final disposition was 6.4 years (±3.3). CONCLUSIONS Obtaining an accurate preoperative diagnosis may decrease malpractice litigation following pancreatic surgery. By raising awareness to unsafe practices and identifying vulnerable periods of care, these data may serve to enhance provider performance as well as improve patient safety.
Collapse
Affiliation(s)
- Roi Anteby
- School of Public Health, Harvard University, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
12
|
O’Connell RL, Patani N, Machin JT, Briggs TWR, Irvine T, MacNeill FA. Litigation in breast surgery: unique insights from the English National Health Service experience. BJS Open 2021; 5:zraa068. [PMID: 33972991 PMCID: PMC8110893 DOI: 10.1093/bjsopen/zraa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The increase in medical negligence claims against the National Health Service (NHS) over the past decade has had a detrimental impact on limited financial and human resources that could otherwise be available for direct clinical care. The aim of this study was to review litigation claims in breast surgery as part of the national Getting It Right First Time quality improvement initiative, with the aim of identifying opportunities to improve clinical practice and patient safety. METHODS All general and plastic surgical claims notified to NHS Resolution between April 2012 and April 2018 were reviewed. Claims related specifically to breast surgery were retrieved manually, and case summaries were analysed independently by two breast surgeons. RESULTS From 6915 claims, 449 relating to breast surgery were identified and reviewed. The mean(s.d.) claimant age was 46(13) years. The median number of claims over the 6-year period per NHS trust was 2 (range 0-22). The most frequent causes of litigation were dissatisfaction with cosmetic outcome (121 claims, 26.9 per cent) and patient-reported delays in diagnosis (121, 26.9 per cent). A large proportion of claims related to breast implant surgery (78, 17.4 per cent), and issues regarding consent/communication were common (69, 15.4 per cent). The estimated annual cost of breast surgery litigation claims ranged from £5.57 to £9.59 million (€6.35-11.02 million). CONCLUSION Patient-reported delays in diagnosis and dissatisfaction with cosmetic outcome are the most common causes of litigation related to breast surgery. These key themes should be the focus for workforce learning, with the aim of improving patient care and experience.
Collapse
Affiliation(s)
- R L O’Connell
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - N Patani
- Department of Breast Surgery, University College Hospital, London, UK
- University College London Cancer Institute, Francis Crick Institute, London, UK
| | - J T Machin
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
- National GIRFT programme, NHS England and Improvement, UK
| | - T W R Briggs
- National GIRFT programme, NHS England and Improvement, UK
- Sarcoma Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - T Irvine
- National GIRFT programme, NHS England and Improvement, UK
- Department of Breast Surgery, Royal Surrey County Hospital, Guildford, UK
| | - F A MacNeill
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, London, UK
- National GIRFT programme, NHS England and Improvement, UK
| |
Collapse
|
13
|
Parikh JR, Sun J, Mainiero MB. What Causes the Most Stress in Breast Radiology Practice? A Survey of Members of the Society of Breast Imaging. JOURNAL OF BREAST IMAGING 2021; 3:332-342. [PMID: 34056593 PMCID: PMC8139609 DOI: 10.1093/jbi/wbab012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study is to determine the major stressors affecting practicing breast radiologists. METHODS All members of the Society of Breast Imaging within the United States received an email invitation to complete an anonymous survey evaluating stressors that may contribute to physician burnout. Stressors evaluated included pace at work, work-life balance, care of dependents, job security, financial strain, decreasing reimbursement, new regulations, delivering bad news, fear of getting sued, and dealing with difficult patients, radiologists, and administrators. RESULTS The overall response rate was 13.5% (312/2308). For those who opened the email, response rate was 24.6% (312/1269). The most prevalent stressors reported were working too fast (222/312, 71.2%), balancing demands of work with personal life (209/312, 70.0%), fear of getting sued (164/312, 52.6%), and dealing with difficult administrators (156/312, 50%). Prevalence of stress related to new regulation requirements, job security, financial strain, decreased reimbursement, dependent care, call, delivering bad news, and dealing with difficult patients, difficult referrers, and difficult radiologists were present in fewer than 50% of respondents. CONCLUSION The most prevalent sources of stress in breast imaging radiologists relate to working too fast and balancing demands of work with time needed for personal life.
Collapse
Affiliation(s)
- Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
| | - Jia Sun
- University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX, USA
| | - Martha B Mainiero
- Alpert Medical School of Brown University, Department of Diagnostic Imaging, Providence, RI, USA
| |
Collapse
|
14
|
Bartlett EC, Silva M, Callister ME, Devaraj A. False-Negative Results in Lung Cancer Screening-Evidence and Controversies. J Thorac Oncol 2021; 16:912-921. [PMID: 33545386 DOI: 10.1016/j.jtho.2021.01.1607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/22/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022]
Abstract
Identifying false-negative cases is an important quality metric in lung cancer screening, but it has been infrequently and variably reported in previous studies. Although as a proportion of all screening participants, false-negative cases are uncommon, such cases may constitute a substantial proportion of all lung cancers diagnosed (up to 15%) within a screening program. This article reviews the impact and causes of false-negative lung cancer screening tests, including those related to radiologic evaluation, nodule management protocols, and management decisions made by multidisciplinary teams. Following a review of data from international screening studies, this article discusses the controversies within the screening literature surrounding the definition and classification of a false-negative lung cancer screening test and how data on false-negative rates should be captured and recorded. Challenges, such as avoiding overly cautious surveillance of lung nodules while minimizing overdiagnosis and investigation of indolent or benign lesions, are considered. Finally, the advantages and disadvantages of different approaches to dealing with false-negative results in lung cancer screening are discussed.
Collapse
Affiliation(s)
- Emily C Bartlett
- Department of Radiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mario Silva
- Section of "Scienze Radiologiche," Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Matthew E Callister
- St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| |
Collapse
|
15
|
Tharp K, Branach C, Duszak R. Relative Prevalence and Characteristics of Malpractice Litigation Involving Radiology Trainees. J Am Coll Radiol 2020; 18:608-614. [PMID: 33197407 DOI: 10.1016/j.jacr.2020.09.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the prevalence and characteristics of medical malpractice litigation involving radiology trainees. METHODS Using a LexisNexis legal database keyword search, we identified all state and federal lawsuits between 2009 and 2018 yielding formal appellate and lower court opinions (precedent setting "complex litigation") potentially involving physician trainees. Available judicial records were systematically reviewed to identify malpractice matters with material trainee involvement. Cases were categorized by criteria including specialty and location. Incidence rates were calculated for all specialties. Radiology lawsuits were characterized further. RESULTS Initial LexisNexis Boolean database search yielded 8,935 potentially relevant cases with 580 confirmed as malpractice materially involving physician trainees. Annual cases trended downward (high 70, low 37). Most originated in New York (195 of 580; 33.6%), Ohio (41; 7.1%), and Pennsylvania (34; 5.9%) and involved surgery (204; 35.2%), obstetrics and gynecology (114; 19.7%), and medicine (105; 18.1%). The case incidence rate for all trainees was 0.63 per 1,000 trainee years. Of 309 cases with known outcomes, defendant physicians prevailed in 238 (77.0%). Radiology trainees represented only 23 cases (4.0%), corresponding to an incidence rate ratio of 0.79 (confidence interval 0.52-1.20). Radiology litigation most frequently involved alleged missed diagnoses (14 of 23; 60.8%) and procedural complications (7; 30.4%). Defendant radiologists prevailed in 9 of the 13 cases with known outcomes (69.2%). CONCLUSION Complex medical malpractice litigation involving physician trainees is infrequent and decreasing over time. Lawsuits involving radiology trainees are uncommon, less likely than for many nonradiology trainees, and typically involve alleged missed diagnoses or procedural complications. Defendant radiologists usually prevail.
Collapse
Affiliation(s)
- Kenneth Tharp
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Casey Branach
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Richard Duszak
- Professor and Vice Chair for Health Policy and Practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|