Guidelines offered to help radiologists avoid lawsuits

Mission statements are key

Radiologists should clearly say in their mission statements that "productivity is a far less important factor in the determination of income" than "optimal care," says Leonard Berlin, MD, a well-known expert in malpractice issues in radiology. In an article in the July 2000 American Journal of Roentgenology, 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 to 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 filed the lawsuit eight months later.

"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 writes. He also presents these 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 to 70 diagnostic procedures a day, while noting these studies contain disclaimers showing that many factors affect daily workloads for radiologists. Those 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 workday.

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" 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 the 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.