Disclosing Harmful Mammography Errors to Patients

Although many professional medical organizations recommend disclosing errors to patients, studies suggest that disclosure is the exception rather than the rule. Mammography poses several issues related to error disclosure, including that—because of regular screening mammograms—many patients have access to records that can be examined when cancer is diagnosed. In addition, radiologists are among the most highly sued doctors, and failure to accurately diagnose breast cancer, or a delay in diagnosis, are two of the most common causes of medical litigation.

Although the need for such studies seems high, little research examining radiologists’ willingness to disclose mammography-related errors has been conducted. This study used a survey tool sent to 364 radiologists at seven Breast Cancer Surveillance Consortium sites. The survey included a vignette describing a scenario in which an error was made that delayed a patient’s breast cancer diagnosis, due to a comparison screening mammogram being placed in the wrong order so that a patient’s calcifications were misread as getting smaller rather than larger. Radiologists were asked how likely they were to disclose the error; what information they would share; and about their attitudes and experiences with malpractice.

Key Findings:

  • Nine percent said they definitely would not disclose the error; 51 percent said only if asked by the patient; 26 percent said probably; and 14 percent said definitely.
  • Regarding information to share, 24 percent said they would say nothing further; 31 percent said they would explain that the calcifications were larger and now suspicious for cancer; 30 percent would state that the calcifications may have increased on the last mammogram but were not as worrisome as they are now; and 15 percent would tell the patient that an error had occurred and the calcifications had actually increased on the last mammogram.
  • Malpractice experiences and attitudes were not consistently associated with disclosure responses.

The authors conclude that strategies must be developed and implemented to encourage radiologists to communicate errors to patients. Although this study had several limitations, the authors’ work in other clinical areas looking at physician willingness to disclose errors, showed a similar range of results.