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Breast Imaging |
1 From the Dept of Internal Medicine, Univ of Washington School of Medicine, Harborview Medical Ctr, 325 Ninth Ave, Box 359780, Seattle, WA 98104-2499 (J.G.E., J.S.F.); Ctr for Health Studies, Group Health Cooperative, Seattle, Wash (J.G.E., S.H.T., W.E.B., L.A.A.); Applied Research Program, National Cancer Institute, Bethesda, Md (S.H.T.); Cancer Research and Biostatistics, Seattle, Wash (W.E.B.); Dept of Biostatistics, Univ of Alabama at Birmingham, Birmingham, Ala (G.R.C.); Dept of Radiology, Emory University, Atlanta, Ga (C.J.D.); Lynn Sage Comprehensive Breast Ctr, Dept of Radiology, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (R.E.H.); and Office of Medical Education, Dartmouth Univ, Hanover, NH (P.A.C.). Supported by Public Health Service grant HS-10591 (J.G.E.) from the Agency for Healthcare Research and Quality and the National Cancer Institute and surveillance grants U01 CA63731 (S.H.T.), 1 U01 CA86082-01 (P.A.C.), 5 U01 CA63736-09 (G.R.C.), and 5 U01 CA86076 (W.E.B.) from NIH and the Department of Health and Human Services and the National Cancer Institute. Received Mar 17, 2004; revision requested May 27; revision received Jul 30; accepted Sep 2. Address correspondence to J.G.E. (e-mail: jelmore{at}u.washington.edu).
PURPOSE: To assess the relationship between radiologists' perception of and experience with medical malpractice and their patient-recall rates in actual community-based clinical settings.
MATERIALS AND METHODS: All study activities were approved by the institutional review boards of the involved institutions, and patient and radiologist informed consent was obtained where necessary. This study was performed in three regions of the United States (Washington, Colorado, and New Hampshire). Radiologists who routinely interpret mammograms completed a mailed survey that included questions on demographic data, practice environment, and medical malpractice. Survey responses were linked to interpretive performance for all screening mammography examinations performed between January 1, 1996, and December 31, 2001. The odds of recall were modeled by using logistic regression analysis based on generalized estimating equations that adjust for study region.
RESULTS: Of 181 eligible radiologists, 139 (76.8%) returned the survey with full consent. The analysis included 124 radiologists who had interpreted a total of 557 143 screening mammograms. Approximately half (64 of 122 [52.4%]) of the radiologists reported a prior malpractice claim, with 18 (14.8%) reporting mammography-related claims. The majority (n = 51 [81.0%]) of the 63 radiologists who responded to a question regarding the degree of stress caused by a medical malpractice claim described the experience as very or extremely stressful. More than three of every four radiologists (ie, 94 [76.4%] of 123) expressed concern about the impact medical malpractice has on mammography practice, with over half (72 [58.5%] of 123) indicating that their concern moderately to greatly increased the number of their recommendations for breast biopsies. Radiologists' estimates of their future malpractice risk were substantially higher than the actual historical risk. Almost one of every three radiologists (43 of 122 [35.3%]) had considered withdrawing from mammogram interpretation because of malpractice concerns. No significant association was found between recall rates and radiologists' experiences or perceptions of medical malpractice.
CONCLUSION: U.S. radiologists are extremely concerned about medical malpractice and report that this concern affects their recall rates and biopsy recommendations. However, medical malpractice experience and concerns were not associated with recall or false-positive rates. Heightened concern of almost all radiologists may be a key reason that recall rates are higher in the United States than in other countries, but this hypothesis requires further study.
© RSNA, 2005
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