These malpractice allegations are common in failure to diagnose’ claims against OB/GYNS
An elderly patient receives two breast exams in the year prior to her cancer diagnosis, but there is no record of a mammogram or ultrasound being ordered or performed in that year or the two preceding ones.
Then, "when a routine mammogram is finally performed, it shows a mass, which is found to be cancerous," says Stella M. Dantas, MD, chair of the American Congress of Obstetricians and Gynecologists (ACOG) Committee on Professional Liability. In this case, the plaintiff alleged that the appropriate diagnostic test was not ordered.
Another malpractice case involved a patient with an abnormal mammogram who was referred to a breast surgeon by her obstetrician/gynecologist (OB/GYN) A biopsy was scheduled, but the patient cancelled. "The allegation with this case was the provider did not set up appropriate follow-up plans," Dantas says.
Failure to perform an adequate physical exam, failure to find the tumor of concern during an exam, and failure to recommend a referral are common in claims naming OB/GYNs, she says.
In the 2012 ACOG Survey on Professional Liability, delay in or failure to diagnose was the second most frequent primary allegation, after "patient injury-major" claims. Failure to diagnose cancer was most common (41.8%). The most frequent types of cancer involved in these claims were breast cancer (39.1%), ovarian cancer (14.5%), and cervical cancer (10.9%).
Dantas says that a common characteristic of plaintiffs in claims alleging delayed diagnosis of breast cancer is that they are often young, with a self-discovered breast mass and a negative mammogram. Sometimes doctors can be skeptical when considering the possibility of breast cancer in young women, especially when relying on negative mammograms and not recognizing that mammograms can be falsely negative, she says.
To avoid failure to diagnose suits, Dantas says OB/GYNs should:
• Follow national guidelines.
• Strongly encourage patients to follow up and obtain recommended tests.
• Not hesitate to make referrals for consultations and imaging studies.
• Set up tracking system for results and follow-up, to make sure recommended care is obtained.
"Most jurors would consider it the physician’s responsibility to make a reasonable effort to ensure that a patient receives the care that was recommended," says Dantas.
• If a test is not ordered for any given reason, this situation needs to be documented in detail. The documentation should show that the patient understands the reasoning behind why a test is not ordered.
Dantas says OB/GYNs should remember two important things about their patients: Not all tests are always accurate, and not all patients will do the tests that are ordered.
"Patients and doctors want to make sure nothing is missed. If doctors are diligent and thorough, they are not only providing good care; they are also decreasing their liability, says Dantas. F