Be Careful to Not Willingly Suspend Disbelief

Analysis of malpractice claims in mammography: a complex issue

PURPOSE

The aim of this study was to analyse malpractice claims in mammography, estimate the specific risk of future claims and assess their impact on radiologists and society.

MATERIALS AND METHODS

The study considered insurance claims filed by radiologists of the Italian Society of Medical Radiology (SIRM) over a 12.5-year period between 1 January 1993 and 30 June 2005. We isolated claims related to presumed diagnostic errors in mammography. We then estimated the number of claims arising from events in the study period that are expected to be filed over the next few years, before the expiration of the prescriptive period of 10 years.

RESULTS

The total number of claims was 1,088. Of these, 302 were caused by alleged diagnostic errors in cases of cancer; 189 (62%) concerned breast cancers and mammographic technique. Assuming a constant frequency of claims filed by radiologists, we expect a further 637 claims relating to the study period, for a total of 1,725 claims, with 178 claims being related to breast imaging. The predicted rate therefore increases to 10.5 per thousand, equal to a risk of one litigation per radiologist per 10 years of work.

CONCLUSIONS

The analysis uncovered a complex problem: although radiologists save many lives through the radiographic diagnosis of breast cancer and consequently contribute to the welfare of society, in practice, they can face real or alleged errors, with serious judicial consequences. Awareness of professional risk in current society may represent a valuable reference for choosing and planning to work in radiology.

The practice of ethics in the era of evidence-based radiology

Various methods to provide an ethical conscience in the modern practice of radiology are available, but they all require time and effort. Although this is part of a series dedicated to evidence-based radiology (EBR), this article cannot provide recommendations supported by evidence. However, the method we propose is inspired from the analytic process found in EBR. It emphasizes autonomous reflection; systematic identification of roles, motives, and consequences of current actions and organizations; clarification of aims and means; selection of principles and values; and equilibration, application, and validation. This personal process is followed by the search for common values shared by the group, in a rational, scientific context centered on preserving the patient-physician relationship. This method entails constant vigilance and repeated revisions, but the allowance of time to think about ethical matters can decrease confusion and moral perplexity. The result is a stronger moral personal identity and a brighter horizon for a satisfying professional life.

The Expert Witness: Understanding the Rationale

The origins of the use of expert witnesses to assist courts in helping understand the required conduct in determining the standard of care provides a basis for recognizing the consultant role sought in judicial proceedings. Both rules of evidence and court decisions have evolved in a manner that encourages the introduction of expert testimony while conditioning its use to avoid unfair bias. Trial court judges decide on permitting such testimony, while legal counsel is responsible for helping juries determine its importance and reliability. Certain types of restrictions and adverse consequences for misstatements exist but are subordinated to the trial process in most circumstances, a process that varies among different jurisdictions.