Malpractice Fear May Bias Mammogram Decisions

Radiologists' concerns about medical malpractice may influence their decisions on 1 whether to recommend repeat mammograms or biopsies, according to new research.

"There is a lot in the news about malpractice and litigation, but very little scientific data about how the malpractice climate could be influencing the practice of care in the United States," says study author Joann G. Elmore, an associate professor of medicine at the University of Washington in Seattle, who researches the differences in the rates of recall, or repeat, mammograms.

The Study

Elmore's research analyzed input from 124 radiologists located in three states-Washington, Colorado and New Hampshire-who together interpreted more than 557,000 screening mammograms.

Approximately half of the radiologists had malpractice claims filed against them, and nearly 15% of those claims were related to a mammogram.

Not surprisingly, radiologists consider malpractice claims very stressful. Elmore found that 81% of the radiologists who answered questions regarding the anxieties of experiencing a malpractice claim described it as "very" or "extremely stressful.

Her study also revealed that 72% of radiologists believe their malpractice fears moderately or greatly increase the number of recommendations they make for either ultrasound or repeat mammography.

In addition, 59% say their concerns about medical malpractice increase the number of recommendations they make for breast biopsy.

The Reaction

These results are not surprising to Dr. Leonard Berlin, chairman of the department of radiology at Rush North Shore Medical Center, in Skokie, Illinois. "If anything, they are understating the concern," he says.

The trend, says Berlin, is for doctors today to be sued not for acts of commission, such as ordering further tests, but for acts of omission, such as not detecting breast cancer in its early stages.

Radiologists are understandably concerned about the possibility of being sued if they see something slightly abnormal on a screening mammogram and do not recommend either a repeat test, an ultrasound or a biopsy for fear the abnormality is or will develop into-cancer, says Berlin.

Don’t Be Alarmed

The message for consumers, say Berlin and Elmore, is that understanding the reasoning behind some of these recalls may make the process less anxiety-producing.

When recalled, women should try not to be alarmed. Patients should also realize that most of the time the recall is going to turn out to be nothing, according to Berlin.

"The recall rate in the US is much higher than in other countries," Elmore says. "We have a different threshold for our alarms compared to other countries." And, she believes the reason for this is the many malpractice suits brought against American doctors. Radiologists now "have to practice defensively," Berlin says.

Bottom Line

Patients who want to reduce the odds of getting called back for repeat or additional testing should be sure to go to the same facility each year, says Elmore. That increases the chance your mammogram will be done on the same machine and read by the same person. The facility can also easily compare this year's result with previous ones.

With time, however, the odds of getting called back for a repeat test will increase, Elmore says, and it may help to understand that that's perfectly normal.

"After 10 mammograms, you have a 50% chance of having at least one recall, and a 20% chance of having a biopsy," she says, citing her own research on the topic.