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Follow these tips to reduce your risk of breast cancer lawsuits

Radiology Administrator's Compliance and Reimbursement Insider, February 1, 2006

Patients or their families who file breast cancer malpractice lawsuits generally do so because of several basic factors. Awareness of these common factors can be crucial to fending off potential litigation. Younger-than-usual patients, self-discovery of lumps, poor radiology equipment, and lack of personal connection with patients may lead to lawsuits, says Maureen Mondor, vice president of risk management at Pro-Mutual Group in Boston. However, knowledge is power. Understanding such litigation statistics can help you address these risk factors. If your facility takes steps to fix such trouble spots, you greatly reduce your chances of being taken to court. Mondor offers the following tips to prevent lawsuits at your facility:

1. Open the path to good communication.

Perhaps the biggest precursor to litigation is poor communication. It's not just a doctor/patient problem, either. Intra- and interdepartment discussions in hospital settings often break down at one point or another. Hold short weekly meetings with radiologists, breast surgeons, and primary care physicians (PCP) to discuss cases and prevent miscommunication, says Mondor. Take extra steps to make sure that patients at risk for problems receive timely follow-up care when an initial examination raises concerns. For example, if a radiologist sees a borderline image on a mammogram and thinks the patient should return in three to six months for a follow-up exam, he or she should communicate that information effectively so the PCP can help his or her patient comply. This step also keeps the lines of communication open, Mondor says.

2. Foster patient-radiologist relationships.

Smaller women's breast health centers--where patients benefit from more one-on-one interaction with radiologists and doctors--are less likely to face malpractice suits, Mondor says. Personal relationships and patient rapport go a long way toward preventing potential problems, she says. A physician or radiologist who doesn't have a personal relationship with the patient could meet more legal challenges down the line. Encourage practitioners to take whatever steps they can to meet with, and establish a bond with their patients.

3. Encourage breast self-exams; don't discount the results.

Breast self-exams may appear to be common practice, but some physicians still downplay their importance, Mondor says.

"There are physicians out there [who] tell women they don't need to do breast self-exams." Make sure practitioners stress the importance of breast self-exams. Failure to do so may leave your facility--and your patients--vulnerable to risk. In 87% of breast cancer malpractice cases, the women filing suits found the lumps themselves, says Mondor. If a patient discovers the cancer herself, there could be a breakdown in the trust between the doctor and patient. Often such events lead to poor communication with the physician or failure by the physician to follow up. These delays in a woman's cancer diagnosis can lead to a lawsuit. When a lump is discovered--even if the mammogram comes back negative--it is critical for screening centers and physicians to take such findings seriously and to ensure adequate follow-up.

4.Track follow-up measures to guarantee accurate diagnosis.

Lack of follow-up is the leading reason that patients file lawsuits related to breast cancer. That's why your facility must develop a system to track follow-up care. When a woman comes into your facility with a lump, designate a person to palpate and mark these findings during the mammogram. If the mammogram returns with a negative reading but the lump is still there, consider performing an ultrasound, Mondor says. In 15%-20% of cases, a palpable malignancy cannot be visualized on a mammogram, she says. Tell patients this information because many do not understand mammography's limitations.

5. Be mindful of breast cancer risks in younger women.

The median age of those suing for breast cancer-related malpractice was previously 41. Today, it's about 38 or 39, Mondor says. Typically, these women have aggressive cancers. In some cases, says Mondor, special circumstances (e.g., a current or recent pregnancy) make the circumstances all the more tragic--and lawsuits all the more heart-wrenching in the eyes of a jury. During the past five years alone, Mondor has seen 17 cases involving women who had recently given birth. Physicians aren't always on the lookout for these cases. This lack of awareness makes such cases particularly dangerous. Conducting breast exams at the six-week postpartum visit and at patients' annual appointments help reduce this risk. When working with younger women, ask specifically about family history related to breast cancer. Flag those with prevalent breast cancer cases as high-risk patients. Give them extra attention and encourage additional follow-up and screening measures. Other young women to watch carefully are those with repeat microcalcifications, says Mondor.

6.Avoid risky reading environments.

Consider the condition of your radiology facility when considering how to avoid breast cancer malpractice lawsuits. A ProMutual analysis found that patients are more likely to sue healthcare agencies that lack a designated reading room for radiologists, says Mondor. At some facilities, radiologists read scans in high-traffic areas where they face frequent interruptions. This arrangement increases the likelihood that a radiologist will miss a cancer or cancer precursor. Missed cancers can lead to malpractice lawsuits.

"We see a percentage of radiologists [who] have multiple claims against them. When we go into the facility, it's easy to understand why--it's a three-ring circus. They are constantly interrupted when they are trying to read," says Mondor. In addition, make sure radiologists use adequate equipment for reading. For example, does the radiologist read exams at night? Does the radiologist who works from his or her home use a substandard monitor? Ingredients such as these could create a recipe for litigation.

7. Keep radiologists on top of their game.

Radiologist fatigue may also lead to missed cancers. Many facilities have radiologists read exams during the day after they have worked all night on call. Although this scenario may be difficult to avoid in hospitals with limited staff, prevent it whenever possible. Such practices can result in a missed diagnosis. In addition, don't ignore the obvious issues that may hinder radiologist performance. For example,

"when is the last time your radiologists had their eyes checked?" asks Mondor. If a radiologist hasn't undergone an exam recently, his or her poor sight could be a liability issue. Require mandatory eye examinations as part of the hospital's credentialing process.

Insider source Maureen Mondor, vice president, risk management, ProMutual Group, Boston; mmondor@promutualgroup.com.

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