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Tharp K, Santavicca S, Hughes DR, Kishore D, Banja JD, Duszak R. Characteristics of Radiologists Serving as Medical Malpractice Expert Witnesses for Defense Versus Plaintiff. J Am Coll Radiol 2022; 19:807-813. [PMID: 35654146 DOI: 10.1016/j.jacr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Previous studies have reported higher qualification characteristics for anesthesiologists, neurosurgeons, orthopedic surgeons, and otolaryngologists serving as defense (versus plaintiff) medical malpractice expert witnesses. We assessed such characteristics for radiologist expert witnesses. METHODS Using the Westlaw legal research database, we identified radiologists serving as experts in all indexed medical malpractice cases between 2010 and 2019. Online databases were used to identify years of practice experience and scholarly bibliometrics. Using Medicare claims, individual radiologist practice types and mixes were ascertained. Radiologists testifying at least once each for defense and plaintiff were excluded from our defense-only versus plaintiff-only comparative analysis. RESULTS Initial Boolean searches yielded 1,042 potential cases; subsequent manual review identified 179 radiologists testifying in 231 lawsuits: 143 testified in one case (58 defense, 85 plaintiff) and 36 testified in multiple cases (10 defense-only, 14 plaintiff-only, 12 both). The 68 defense-only experts had fewer years of practice experience than the 99 plaintiff-only experts (28.3 versus 31.8 years, P = .02), but the two groups were otherwise similar in both practice type (44.6% versus 54.9% academic, P = .62) and mix (63.8% versus 65.8% practiced as subspecialists, P = .37) and as well as numbers of publications (60.5 versus 62.8, P = .86), citations (1,994.1 versus 2,309.2, P = .56), and h-indices (17.2 versus 16.8, P = .89). CONCLUSIONS In contrast to other specialists, radiologists serving as medical malpractice expert witnesses for defense and plaintiff display similar qualifications across various characteristics. Published practice parameter guidelines and experts' ability to blindly review archived original images might together explain this interspecialty discordance.
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Affiliation(s)
- Kenneth Tharp
- Department of Radiology and Imaging Sciences, Emory University School of Medicine.
| | - Stefan Santavicca
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Danny R Hughes
- Department of Radiology and Imaging Sciences, Emory University School of Medicine; Director of the Health Economics and Analytics Laboratory (HEAL), School of Economics, Georgia Institute of Technology
| | - Divya Kishore
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | | | - Richard Duszak
- Vice Chair of the Department of Radiology and Imaging Sciences, and Director of the Imaging Policy Analytics for Clinical Transformation (IMPACT) Research Center, Department of Radiology and Imaging Sciences, Emory University School of Medicine; ACR Board of Chancellors
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2
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Hiding Waldo. J Am Coll Radiol 2022; 19:814-815. [DOI: 10.1016/j.jacr.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
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3
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Wynn JD. Coping With Radiology Malpractice Litigation. J Am Coll Radiol 2022; 19:829-833. [PMID: 35341698 DOI: 10.1016/j.jacr.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- John David Wynn
- private practice and is a Clinical Professor, Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington.
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4
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Chen J, Littlefair S, Reed W. Investigating Visual Hindsight Bias in Medical Imaging. Acad Radiol 2020; 27:1494. [PMID: 32763062 DOI: 10.1016/j.acra.2020.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/24/2020] [Accepted: 05/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jacky Chen
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Cumberland Campus, 75 East Street, Lidcombe, Sydney, NSW 2146, Australia
| | - Stephen Littlefair
- Discipline of Medical Imaging, Central Queensland University, Mackay, Queensland, Australia
| | - Warren Reed
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Cumberland Campus, 75 East Street, Lidcombe, Sydney, NSW 2146, Australia.
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5
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Waite S, Scott J, Kolla S, Bruno MA. The Role of the Expert Witness in Radiology: Challenges and Strategies for Overcoming Them. J Am Coll Radiol 2020; 18:318-323. [PMID: 32628901 DOI: 10.1016/j.jacr.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
Expert witnesses provide an important service in malpractice cases in the United States because they educate the jury on the standards of care relevant to a particular case. In cases in which the defendant physician is a radiologist, the decision often rests on whether a retrospectively detected abnormality should have been perceived and reported, an "error of omission." Errors of omission are usually termed "perceptual" in the literature and are the most common cause of malpractice suits in radiology. Allegations often hinge on whether these errors represent a breach of duty by the defendant radiologist and whether they resulted in an injury to the plaintiff or patient. In short, jurors are asked to decide if the radiologist performed below the "standard of care," generally defined as that which a minimally competent, reasonable, or ordinary physician in the same field would do under similar circumstances. The authors describe challenges associated with being an expert witness and provide guidance to radiologists on how to address cases involving alleged perceptual errors.
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Affiliation(s)
- Stephen Waite
- Chief, Cardiothoracic Section, SUNY Downstate Medical Center, Brooklyn, New York.
| | - Jinel Scott
- SUNY Downstate Medical Center, Brooklyn, New York; Director of Emergency Radiology and Director of Quality Improvement and Patient Safety, Kings County Department of Radiology, Brooklyn, New York
| | - Srinivas Kolla
- Chief, Musculoskeletal Radiology Section, SUNY Downstate Medical Center, Brooklyn, New York
| | - Michael A Bruno
- Chief, Division of Emergency Radiology, and Vice Chair for Quality and Patient Safety, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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6
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Chen J, Littlefair S, Bourne R, Reed WM. The Effect of Visual Hindsight Bias on Radiologist Perception. Acad Radiol 2020; 27:977-984. [PMID: 31740289 DOI: 10.1016/j.acra.2019.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES To measure the effect of visual hindsight bias on radiologists' perception during chest radiograph pulmonary nodule detection. MATERIALS AND METHODS This was a prospective multi-observer study to assess the effect of hindsight bias on radiologists' perception. Sixteen radiologists were asked to interpret 15 postero-anterior chest images containing a solitary lung nodule each consisting of 25 incremental levels of blur. Participants were requested initially to detect the nodule by reducing the blur of the images (foresight). They were then asked to increase the blur until the identified nodule was undetectable (hindsight). Participants then repeated the experiment, after being informed of the potential effects of hindsight bias and asked to counteract these effects. Participants were divided into two groups (experienced and less experienced) and the nodules were given different conspicuity ratings to determine the effect of expertise and task difficulty. Eye tracking technology was also utilised to capture visual search. RESULTS Wilcoxon analysis demonstrated significant differences between foresight and hindsight values of the radiologists (p = 0.02). However, after being informed of hindsight bias, these differences were no longer significant (p = 0.97). Friedman analysis also determined overall significance in the hindsight ratios between nodule conspicuities for both phases (phase 1: p = 0.02; phase 2: p = 0.02). There was no significance difference between the experienced and less experienced groups. CONCLUSION This study demonstrated that radiologists exhibit hindsight bias but appeared to be able to compensate for this phenomenon once its effects were considered. Also, visual hindsight bias appears to be affected by task difficulty with a greater effect occurring with less conspicuous nodules.
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Affiliation(s)
- Jacky Chen
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Cumberland Campus, 75 East Street, Lidcombe, NSW 2141, Australia.
| | - Stephen Littlefair
- Discipline of Medical Imaging, Central Queensland University, Mackay, Queensland, Australia
| | - Roger Bourne
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Cumberland Campus, 75 East Street, Lidcombe, NSW 2141, Australia; Medical Imaging Optimisation Perception Group, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - Warren M Reed
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Cumberland Campus, 75 East Street, Lidcombe, NSW 2141, Australia; Medical Imaging Optimisation Perception Group, Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
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7
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Hindsight Bias-A Tricky Concept to Study in Radiology. Acad Radiol 2020; 27:985-986. [PMID: 32094032 DOI: 10.1016/j.acra.2019.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 11/24/2022]
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8
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Garon-Sayegh P. Analysis of medical malpractice claims to improve quality of care: Cautionary remarks. J Eval Clin Pract 2019; 25:744-750. [PMID: 31069900 DOI: 10.1111/jep.13178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 01/05/2023]
Abstract
Medical malpractice claims can be analysed to gain insights aimed at improving quality of care. However, using medical malpractice claims in medical research raises epistemological and methodological concerns related to certain features of the litigation process. Medical research should therefore approach medical malpractice claims with caution. Taking one recent study as a an example, this article insists on three areas of concern: (a) the quantity of legal materials available for analysis; (b) the content of the legal materials available for analysis; and (c) the ways in which the content of the legal materials should be analysed and the types of inferences that it can support. The article concludes with general recommendations for future medical research that would incorporate medical malpractice claims. These recommendations centre around recognizing the qualitative dimension of legal reasoning.
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Ross MG. Threshold of metabolic acidosis associated with newborn cerebral palsy: medical legal implications. Am J Obstet Gynecol 2019; 220:348-353. [PMID: 30529344 DOI: 10.1016/j.ajog.2018.11.1107] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 12/15/2022]
Abstract
Obstetricians and gynecologists belong to 1 of the medical specialties with the highest rate of litigation claims. Among birth injury cases, those cases with cerebral palsy outcomes account for litigation settlements or judgments often in the millions of dollars. In cases of potential perinatal asphyxia, a threshold level of metabolic acidosis (base deficit ≥12 mmol/L) is necessary to attribute neonatal encephalopathy to an intrapartum hypoxic event. With increasing duration or severity of a hypoxic stress resulting in metabolic acidosis, newborn infant umbilical artery base deficit increases. It may be alleged that, as base deficit levels increase beyond 12 mmol/L, there is an increased likelihood and severity of cerebral palsy. As a corollary, it may be claimed that an earlier delivery (by minutes) would reduce the base deficit and prevent or reduce the severity of cerebral palsy. This issue is of relevance to obstetricians as defendants, because retrospective "expert" analysis of cases may suggest that optimal management decisions would have resulted in an earlier delivery. In addressing the association of metabolic acidosis and cerebral palsy, base deficit should be measured as the extracellular component (base deficitextracellular fluid) rather than the commonly used base deficitblood. Studies suggest that, beyond the base deficit threshold of 12 mmol/L, the incidence and severity of cerebral palsy does not significantly increase (until ≥20 mmol/L), although the risk of neonatal death rises markedly. Thus, among most infants with hypoxia-associated neonatal encephalopathy, the occurrence of cerebral palsy is unlikely to be impacted by delivery time variation of few minutes, and this argument should not serve as the basis for medical legal claims.
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Affiliation(s)
- Michael G Ross
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Department of Obstetrics and Gynecology, Geffen School of Medicine at UCLA, Los Angeles, CA.
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10
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Sotiriadis A, Odibo AO. Systematic error and cognitive bias in obstetric ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:431-435. [PMID: 30701628 DOI: 10.1002/uog.20232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
Linked Comment: Ultrasound Obstet Gynecol 2019; 53: 454-464.
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Affiliation(s)
- A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, 92 Tsimiski Str, 54622, Thessaloniki, Greece
| | - A O Odibo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Itri JN, Tappouni RR, McEachern RO, Pesch AJ, Patel SH. Fundamentals of Diagnostic Error in Imaging. Radiographics 2018; 38:1845-1865. [DOI: 10.1148/rg.2018180021] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jason N. Itri
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
| | - Rafel R. Tappouni
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
| | - Rachel O. McEachern
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
| | - Arthur J. Pesch
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
| | - Sohil H. Patel
- From the Department of Radiology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157-1088 (J.N.I., R.R.T.); and Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (R.O.M., A.J.P., S.H.P.)
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12
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13
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Redefining the Medical Standard of Care: Event-Specific Workflow Analysis. J Am Coll Radiol 2017; 14:1177-1179. [DOI: 10.1016/j.jacr.2017.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/20/2022]
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14
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Reiner BI. Redefining the Practice of Peer Review Through Intelligent Automation Part 1: Creation of a Standardized Methodology and Referenceable Database. J Digit Imaging 2017; 30:530-533. [PMID: 28744582 DOI: 10.1007/s10278-017-0004-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Conventional peer review practice is compromised by a number of well-documented biases, which in turn limit standard of care analysis, which is fundamental to determination of medical malpractice. In addition to these intrinsic biases, other existing deficiencies exist in current peer review including the lack of standardization, objectivity, retrospective practice, and automation. An alternative model to address these deficiencies would be one which is completely blinded to the peer reviewer, requires independent reporting from both parties, utilizes automated data mining techniques for neutral and objective report analysis, and provides data reconciliation for resolution of finding-specific report differences. If properly implemented, this peer review model could result in creation of a standardized referenceable peer review database which could further assist in customizable education, technology refinement, and implementation of real-time context and user-specific decision support.
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Affiliation(s)
- Bruce I Reiner
- Department of Radiology, Veterans Affairs Maryland Healthcare System, 10 North Greene Street, Baltimore, MD, 21201, USA.
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15
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Brady AP. Error and discrepancy in radiology: inevitable or avoidable? Insights Imaging 2016; 8:171-182. [PMID: 27928712 PMCID: PMC5265198 DOI: 10.1007/s13244-016-0534-1] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/07/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022] Open
Abstract
Errors and discrepancies in radiology practice are uncomfortably common, with an estimated day-to-day rate of 3-5% of studies reported, and much higher rates reported in many targeted studies. Nonetheless, the meaning of the terms "error" and "discrepancy" and the relationship to medical negligence are frequently misunderstood. This review outlines the incidence of such events, the ways they can be categorized to aid understanding, and potential contributing factors, both human- and system-based. Possible strategies to minimise error are considered, along with the means of dealing with perceived underperformance when it is identified. The inevitability of imperfection is explained, while the importance of striving to minimise such imperfection is emphasised. TEACHING POINTS • Discrepancies between radiology reports and subsequent patient outcomes are not inevitably errors. • Radiologist reporting performance cannot be perfect, and some errors are inevitable. • Error or discrepancy in radiology reporting does not equate negligence. • Radiologist errors occur for many reasons, both human- and system-derived. • Strategies exist to minimise error causes and to learn from errors made.
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Affiliation(s)
- Adrian P Brady
- Radiology Department, Mercy University Hospital, Cork, Ireland.
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16
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Morgan B, Stephenson JA, Griffin Y. Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer. Clin Radiol 2016; 71:1083-94. [PMID: 27522436 DOI: 10.1016/j.crad.2016.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022]
Abstract
Radiological error is inevitable and usually multifactorial. Error can be secondary to radiologist-specific causes, including cognitive and perceptive errors or ambiguity of report, or system-related causes, including inadequate, misleading, or incorrect clinical information, poor imaging technique, excessive workload, and poor working conditions. In this paper, we discuss a systematic approach to reduce errors in oncological radiology reporting, thus reducing risk to the patient. Rather than attempt to discuss all types of error, we concentrate on the most important and commonly occurring errors that we have encountered over 20 years of practice, based on weekly discrepancy reviews of our practice and independent reviews of clinical and research imaging from other institutions. This review focuses on computed tomography (CT) reporting for staging, surveillance, and response assessment of cancer patients, but the messages apply to all imaging methods.
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Affiliation(s)
- B Morgan
- University of Leicester Imaging Department, Department of Radiology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | - J A Stephenson
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Y Griffin
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
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Littlefair S, Brennan P, Mello-Thoms C, Dung P, Pietryzk M, Talanow R, Reed W. Outcomes Knowledge May Bias Radiological Decision-making. Acad Radiol 2016; 23:760-7. [PMID: 26905454 DOI: 10.1016/j.acra.2016.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES This research investigates whether an expectation of abnormality and prior knowledge might potentially influence the decision-making of radiologists, and discusses the implications for radiological expert witness testimony. MATERIALS AND METHODS This study was a web-based perception experiment. A total of 12 board-certified radiologists were asked to interpret 40 adult chest images (20 abnormal) twice and decide if pulmonary lesions were present. Before the first viewing, a general clinical history was given for all images: cough for 3+ weeks. This was called the "defendants read." Two weeks later, the radiologists were asked to view the same dataset (unaware that the dataset was unchanged). For this reading, the radiologists were given the following information for all images: "These images were reported normal but all of these patients have a lung tumour diagnosed on a subsequent radiograph 6 months later." They were also given the lobar location of the newly diagnosed tumor. This was called the "expert witness read." RESULTS There was a significant difference in location-based sensitivity (W = -45, P = 0.02) between the two conditions with nodule detection increasing under the second condition. Specificity increased outside the lobe of interest (W = 727, P = < 0.0001) and decreased within the lobe of interest (W = -237, P = 0.03) significantly in the "expert witness" read. Case-based sensitivity and case-based specificity were unaffected. CONCLUSIONS This study showed evidence that increased clinical information affects the performance of radiologists. This effect may bias expert witnesses in radiological malpractice litigation.
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Knoll MAZ, Arkes HR. The Effects of Expertise on the Hindsight Bias. JOURNAL OF BEHAVIORAL DECISION MAKING 2016. [DOI: 10.1002/bdm.1950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Hindsight bias occurs when people feel that they "knew it all along," that is, when they believe that an event is more predictable after it becomes known than it was before it became known. Hindsight bias embodies any combination of three aspects: memory distortion, beliefs about events' objective likelihoods, or subjective beliefs about one's own prediction abilities. Hindsight bias stems from (a) cognitive inputs (people selectively recall information consistent with what they now know to be true and engage in sensemaking to impose meaning on their own knowledge), (b) metacognitive inputs (the ease with which a past outcome is understood may be misattributed to its assumed prior likelihood), and (c) motivational inputs (people have a need to see the world as orderly and predictable and to avoid being blamed for problems). Consequences of hindsight bias include myopic attention to a single causal understanding of the past (to the neglect of other reasonable explanations) as well as general overconfidence in the certainty of one's judgments. New technologies for visualizing and understanding data sets may have the unintended consequence of heightening hindsight bias, but an intervention that encourages people to consider alternative causal explanations for a given outcome can reduce hindsight bias.
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Affiliation(s)
- Neal J Roese
- Kellogg School of Management, Northwestern University
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20
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Durand DJ, Robertson CT, Agarwal G, Duszak R, Krupinski EA, Itri JN, Fotenos A, Savoie B, Ding A, Lewin JS. Expert witness blinding strategies to mitigate bias in radiology malpractice cases: a comprehensive review of the literature. J Am Coll Radiol 2014; 11:868-73. [PMID: 25041992 DOI: 10.1016/j.jacr.2014.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/01/2014] [Indexed: 11/17/2022]
Abstract
Like all physicians, radiologists in the United States are subject to frequent and costly medical malpractice claims. Legal scholars and physicians concur that the US civil justice system is neither precise nor accurate in determining whether malpractice has truly occurred in cases in which claims are made. Sometimes, this inaccuracy is driven by biases inherent in medical expert-witness opinions. For example, expert-witness testimony involving "missed" radiology findings can be negatively affected by several cognitive biases, such as contextual bias, hindsight bias, and outcome bias. Biases inherent in the US legal system, such as selection bias, compensation bias, and affiliation bias, also play important roles. Fortunately, many of these biases can be significantly mitigated or eliminated through the use of appropriate blinding techniques. This paper reviews the major works on expert-witness blinding in the legal scholarship and the radiology professional literature. Its purpose is to acquaint the reader with the evidence that unblinded expert-witness testimony is tainted by multiple sources of bias and to examine proposed strategies for addressing these biases through blinding.
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Affiliation(s)
- Daniel J Durand
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | | | - Gautam Agarwal
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jason N Itri
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anthony Fotenos
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brent Savoie
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alexander Ding
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan S Lewin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
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Adam J. Keeping a License to Practice: Prove It or Lose It. J Am Coll Radiol 2011; 8:515-6. [DOI: 10.1016/j.jacr.2011.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 01/13/2011] [Indexed: 10/17/2022]
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22
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Gupta M, Schriger DL, Tabas JA. The Presence of Outcome Bias in Emergency Physician Retrospective Judgments of the Quality of Care. Ann Emerg Med 2011; 57:323-328.e9. [DOI: 10.1016/j.annemergmed.2010.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 10/11/2010] [Accepted: 10/12/2010] [Indexed: 11/24/2022]
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Duszak RS, Duszak R. Malpractice payments by optometrists: An analysis of the national practitioner databank over 18 years. ACTA ACUST UNITED AC 2011; 82:32-7. [DOI: 10.1016/j.optm.2010.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 05/04/2010] [Indexed: 10/19/2022]
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Godwin HJ, Menneer T, Cave KR, Donnelly N. Dual-target search for high and low prevalence X-ray threat targets. VISUAL COGNITION 2010. [DOI: 10.1080/13506285.2010.500605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Impact of Hindsight Bias on Interpretation of Nonenhanced Computed Tomographic Head Scans for Acute Stroke. J Comput Assist Tomogr 2010; 34:229-32. [DOI: 10.1097/rct.0b013e3181c21f72] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE The purpose of this article is to outline common biases in medical reasoning that contribute to avoidable errors in diagnostic and therapeutic decision making. CONCLUSION By recognizing and understanding common biases in medical reasoning, we can more effectively counteract them.
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Olivetti L, Fileni A, De Stefano F, Cazzulani A, Battaglia G, Pescarini L. The legal implications of error in radiology. Radiol Med 2008; 113:599-608. [PMID: 18536873 DOI: 10.1007/s11547-008-0279-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 06/22/2007] [Indexed: 11/28/2022]
Abstract
Evaluation of the legal implications of error in radiology and therefore the assessment of criminal and civil liability in the practice of the profession requires an analysis of how the public perception of the right to health has radically changed. This change has initiated a defensive approach to medicine and radiology that tends to be oriented towards precautionary measures, with a proliferation of often unnecessary imaging studies. In radiology, errors of omission or commission are frequent. A critical appraisal of the different types of error in radiology will help practitioners undertake the essential corrective measures. Through analysis of several cases derived from legal or insurance proceedings brought against radiologists, the most common forms of error are described, and their implications for criminal and civil liability are illustrated, although it is emphasised that the existence of an error does not always translate into the presence of malpractice.
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Affiliation(s)
- L Olivetti
- UO di Radiologia, Dipartimento di Diagnostica per Immagini e Alte Tecnologie, Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy.
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Gordon PB, Borugian MJ, Warren Burhenne LJ. A true screening environment for review of interval breast cancers: pilot study to reduce bias. Radiology 2007; 245:411-5. [PMID: 17848684 DOI: 10.1148/radiol.2451061798] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively assess the feasibility of an uninformed review process to evaluate interval breast cancers and to compare the number of false-negative cancers detected at uninformed review with the number detected at standard informed review. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective study, and informed consent was waived. Mammograms showing interval cancer were included in the daily work of radiologists in a high-volume screening center. Each of three experienced radiologists read studies in the normal screening environment, without knowledge that identifiers had been changed to conceal the fact that studies were not current (ie, uninformed review). Results were compared with the standard review procedure, in which mammograms showing interval cancers were mixed with normal mammograms and read in a panel of 17-20 interval cancers per 80 normal studies by radiologists who were aware that they were participating in a review process (ie, informed review). RESULTS Of 21 interval cancers, six (29%) were interpreted as positive more often by the informed radiologists than by the uninformed radiologists. For 14 (67%) cancers, there was no difference in detection rate between the two groups, and one cancer (5%) was seen by one of the uninformed radiologists but by none of the informed radiologists. The screening environment review process was found to be feasible at the low volumes tested. CONCLUSION The number of false-negative cancers was higher in the informed review than in the uninformed review. This result suggests that bias exists with the informed review process.
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Affiliation(s)
- Paula B Gordon
- Screening Mammography Program of British Columbia, British Columbia Cancer Agency, Vancouver, BC, Canada
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Crosby E. Medical malpractice and anesthesiology: literature review and role of the expert witness. Can J Anaesth 2007; 54:227-41. [PMID: 17331936 DOI: 10.1007/bf03022645] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To provide a narrative review of the physician experience of medical malpractice litigation applied to an anesthesiology case with particular emphasis on the role played by medical expert witnesses. SOURCES Literature searches were conducted of English-language medical publications published between 1996 - 2006 using both Medline and Pubmed databases. Key words included: "medical malpractice"; "medical malpractice litigation"; "medical expert witness"; "expert witness liability", "expert witness bias"; "hindsight bias"; and "outcome bias". PRINCIPAL FINDINGS Patient injury resulting from medical care is common but most injured patients do not sue. Implicit review of medical files is biased to an important degree by the occurrence of severe injury; care is more often deemed substandard when the resulting injury is severe. Expert analysis of medical mal-occurrences is influenced by both hindsight and outcome bias. Compensation for those who do sue is influenced by the severity of injury and the degree of disability. The activity of experts is not commonly subject to review by peers, professional groups or licensing authorities. CONCLUSIONS The legal process for resolving patient claims against physicians is well delineated and transparent; its operational features are complex and prejudiced by severe outcomes. Bias is pervasive in the analysis of medical occurrences and may result in findings against caregivers which are unfair.
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Affiliation(s)
- Edward Crosby
- Department of Anesthesiology, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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Catchpole KR, Giddings AEB, de Leval MR, Peek GJ, Godden PJ, Utley M, Gallivan S, Hirst G, Dale T. Identification of systems failures in successful paediatric cardiac surgery. ERGONOMICS 2006; 49:567-88. [PMID: 16717010 DOI: 10.1080/00140130600568865] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Patient safety will benefit from an approach to human error that examines systemic causes, rather than blames individuals. This study describes a direct observation methodology, based on a threat and error model, prospectively to identify types and sources of systems failures in paediatric cardiac surgery. Of substantive interest were the range, frequency and types of failures that could be identified and whether minor failures could accumulate to form more serious events, as has been the case in other industries. Check lists, notes and video recordings were employed to observe 24 successful operations. A total of 366 failures were recorded. Coordination and communication problems, equipment problems, a relaxed safety culture, patient-related problems and perfusion-related problems were most frequent, with a smaller number of skill, knowledge and decision-making failures. Longer and more risky operations were likely to generate a greater number of minor failures than shorter and lower risk operations, and in seven higher-risk cases frequently occurring minor failures accumulated to threaten the safety of the patient. Non-technical errors were more prevalent than technical errors and task threats were the most prevalent systemic source of error. Adverse events in surgery are likely to be associated with a number of recurring and prospectively identifiable errors. These may be co-incident and cumulative human errors predisposed by threats embedded in the system, rather than due to individual incompetence or negligence. Prospectively identifying and reducing these recurrent failures would lead to improved surgical standards and enhanced patient safety.
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Affiliation(s)
- K R Catchpole
- Royal College of Surgeons of England, Lincoln's Inn Fields, London, WC2A 3PE, UK.
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Harley EM, Carlsen KA, Loftus GR. The "saw-it-all-along" effect: demonstrations of visual hindsight bias. J Exp Psychol Learn Mem Cogn 2004; 30:960-8. [PMID: 15355129 DOI: 10.1037/0278-7393.30.5.960] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors address whether a hindsight bias exists for visual perception tasks. In 3 experiments, participants identified degraded celebrity faces as they resolved to full clarity (Phase 1). Following Phase 1, participants either recalled the level of blur present at the time of Phase 1 identification or predicted the level of blur at which a peer would make an accurate identification. In all experiments, participants overestimated identification performance of naive observers. Visual hindsight bias was greater for more familiar faces--those shown in both phases of the experiment--and was not reduced following instructions to participants to avoid the bias. The authors propose a fluency-misattribution theory to account for the bias and discuss implications for medical malpractice litigation and eyewitness testimony.
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Affiliation(s)
- Erin M Harley
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095-1563, USA.
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Affiliation(s)
- Leonard Berlin
- Department of Radiology, Rush North Shore Medical Center, 9600 Gross Point Rd., Skokie, IL 60076, USA.
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Statistics, Not Memories. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200308000-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Literature review indicates high levels of error within radiology. The aetiology of radiological error is multi-factorial. While individuals have a duty to progressively improve their performance, the experience of safety cultures in other high-risk human activities has shown that a system approach of root cause analysis is the method required to reduce error significantly.
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Affiliation(s)
- R Fitzgerald
- Department of Radiology, New Cross Hospital, Wolverhampton, UK
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