Legal and regulatory issues have a growing impact on how radiologists perform procedures and studies, report results, and structure their practices. Implementing a simple checklist may help to reduce the prospect of being sued for malpractice.
"Most radiologists lack insight on, and guidance to, the relevant issues. This creates an environment of confusion and conflict that benefits neither the radiologist nor the patient," said Dr. Jonathan S. Luchs, a radiologist at Winthrop University Hospital in Mineola, NY, in an education exhibit at RSNA 2008. "There is no single source of information regarding radiology and the law that is incorporated into radiology training to help prepare radiologists for their practice."
Average indemnification has doubled in the past 15 years for all physicians, but it has tripled for radiologists over this period, according to Luchs. In the U.S., radiologists have approximately a one-in-three chance of being sued for malpractice. More than half of radiologists have been sued in Pennsylvania and Oregon, while those in Idaho, New Jersey, Illinois, Louisiana, New York, and Michigan face a 40% to 50% chance of being sued. Florida is infamous for the size of its monetary settlements.
To reduce the risk of a lawsuit, Luchs has the following tips:
- Familiarize yourself with the American College of Radiology standards of practice guidelines.
- Optimize your ambient viewing conditions.
- If you cannot provide a technically adequate exam, refer the patient to someone who can.
- Improve perception and interpretation with a complete clinical history.
- Look at current and previous imaging studies before reading prior reports.
- Consider double reading for challenging cases.
- If your practice consists of many imaging subspecialties, try to allow final interpretation of studies by the most experienced radiologist in each subspecialty.
- Directly communicate interpretations when immediate treatment is needed, when your interpretation can alter management, or when there is a change from a preliminary report.
- If signing a colleague's report, do so with the understanding that you may be held responsible for its contents.
- Offer to give official reports for "curbside" consultations.
- Be aware of the potential obligations of self-referred or third-party-referred patients.
- Communicate all significant abnormal findings in a timely manner.
- Document all communication with date, time, who spoke, and what was said.
- Be familiar with the ACR appropriateness criteria and help guide further management to improve patient outcomes.
