In Dr. Stark’s world as a medico-legal Oncology consultant the single most common reason for patients to sue their doctors is failure to diagnose breast cancer. Among these cases there is an equal division between primary care physicians (typically gynecologists, but also family practitioners and internists) failure to appreciate the significance of an abnormal breast exam and radiologists failing to interpret a mammogram properly. It is his impression that plaintiff’s attorneys are having a field day with what he calls “gotcha” litigation, viz., looking back at an old mammogram and saying, “See, there it is, you stupid doctor!” The Radiology Society of North America, through their journal Radiology, has weighed in. In the February 2013 issue of Radiology a study was published in which the litigation experience of over 8000 radiologists was reviewed. If you want a copy of the article email Dr. Stark using the form on the right of this page. The most common reason radiologists in the US get sued today is failing to diagnose breast cancer. The leading cause used to be missing a fracture, but breast cancer has taken over the lead. The frequency approaches a stunning number: about 1% of all radiologists each year are sued for missing a breast cancer, typically on a screening mammogram. That means that a radiologist has about a one in three chance over the course of a typical career of being sued over this one issue. The study also showed that the chances of a radiologist being sued at least once during his career approaches 100%.
So what happens with the lawsuits? The article does not address this. In his experience, Dr. Stark has observed that juries are much more tolerant of radiology errors than one would imagine. Conventional wisdom, especially among plaintiff’s lawyers, is that once jurors have several days to look at a mammogram in a courtroom they will wonder how anyone could miss the area circled in crayon on the x-ray; however, in his experience, most missed mammogram claims that get to a jury result in a verdict for the doctor. Jurors appreciate how difficult reading mammograms really is. On the other hand, many of these cases are not subtle and result in an out of court settlement.
How has computer assisted mammogram reading impacted on this problem? How much better are radiologists now that digital mammography has largely replaced analogue? It is everyone’s impression that both of these developments have aided in radiology diagnosis of breast cancer. Breast MRI has also helped. However, human error can not be eliminated, and so every mammogram is a potential lawsuit. Perhaps that is why some radiologists have given up reading mammograms completely. It’s just too nerve-wracking.