RSNA 2009: Winding Down, Malpractice Ammo and a Missing Dog
Sure, the pace relaxes a tad and crowds always thin a little on the Thursday of RSNA week, but McCormick Place was anything but a ghost town yesterday. Even the morning Refresher Course "Malpractice Minefields in Radiology: Mammography, Interventional Procedures and Failure of Communication" didn't scare attendees off. In fact, rather the opposite.
The talk, featuring well-known breast imaging experts Robert A. Schmidt, MD, and Robert L. Vogelzang, MD, along with radiology's legal czar Leonard Berlin, MD, was ripe with great quotes, interesting nuggets and helpful advice. Here's a sampling:
From Dr. Schmidt, who spoke on litigation in mammography:
- Mammography is the most frequent exam involved in malpractice cases.
- There's a scarcity of eyes-on-training courses for mammography, which needs to change.
- "Most doctors know as much about the legal system as their patients know about medicine."
- Delay in breast cancer diagnosis is now the most common cause of medical malpractice lawsuits.
- "Ultrasound is your second best friend in life (after your spouse)...Always, always, always do an ultrasound when there is a palpable lesion."
- Lawyers almost always read the standards, such as ACR's--and you should, too.
- The 5 C's of the defendant physician are: caring, credible, consistent, competent and comprehensive.
From Dr. Vogelzang, who spoke on litigation in interventional radiology:
- The presence of a complication in and of itself is not the big problem. More frequently, it's the failure to recognize it.
- With complications, the common, known or expected are typically those that result in litigation. The unexpected, not heard of and catastrophic are far less common among cases, and they're far less likely to win in court.
- What gets interventional radiologists into trouble is "not knowing what you don't know"--inexperience, new procedures, poor patient selection, lack of knowledge regarding the tools, not having the right tools and bad luck, among other causes.
- "Death will get you sued." Other causes include amputation, hemorrhage and contrast extravasation.
- "With law, the system and culture are very unlike medicine. I think we're certainly different human beings sometimes." The field of law is formal, systematic, has defined rules, is highly structured and is formally adversarial; the medical field is pretty much the opposite.
- Informed consent is almost never a legal issue.
From Dr. Berlin, who spoke on the failure to communicate:
- Failure to communicate a finding has the second highest average of indemnification.
- The big problem is with significant findings that aren't urgent. The urgent ones are communicated; the nonurgent ones are more likely to get lost in a shuffle of complacency.
- Courts are pretty much unanimous about the need for radiologists to communicate a significant finding.
- The average juror knows that expert witnesses lie. But they do typically support/believe published guidelines by a relevant society, such as the ACR.
- Document, document, document. Include the type of communication, date, time, name of people and any pertinent extemporaneous notes made at the time of communication. Those notes carry great weight legally.
- It's OK to have a secretary or technologist communicate the findings.
In other news, the exhibit hall floor was easier to navigate before the 2 pm breakdown. Along with exciting information generated in the booths, the booths themselves didn't disappoint. Exhibit highlights included a fireplace, a huge, electronic billboard; water features; moving lit-up logos on the floor; trees, maps to navigate a booth's extensive floor plan; and, of course, the usual conference rooms, theatres with live presentations, lounge areas and more. I didn't see any live animals this year, although a source told me about a Chihuahua that got loose during Carestream's "Nature-of-Diamonds" gala at the Field Museum. Security was not too pleased. Sorry I missed it.
That's the RSNA for you: practical news you can use coupled with a touch of astonishment. Can't wait til next year!