By Andi Lucas
We've all heard that mammography carries some of the most expensive
malpractice insurance in healthcare, that it's the loss leader for
facilities, that fewer physicians are becoming dedicated breast
imagers, that fewer facilities are offering mammography services
and many that do are closing their doors the bad news just keeps
Exacerbating the problem is the growing population of women over
the age of 40 and their need for access to mammograms every 1-2
years. Due to the high risk of malpractice claims that comes with
offering this service, access has not been easy.
I spoke with Bonnie Rush, RT(R) (M)(QM), the president of Breast
Imaging Specialists (San Diego) and the author of MQSA Made Easy:
Understanding and Implementing the Facility-Based Final Regulations.
Rush speaks frequently on the topic of reducing the risk of malpractice
claims in mammography, and she has some simple methods for doing
so. Ultimately, her advice boils down to effective communication.
First, facilities need to make sure that the patient divulges all
of the necessary information about her current and past breast health,
a step that begins with the appointment scheduler. Along with focused
questions that he or she should ask of the patient (eg, have you
noticed any changes to your breasts?), Rush suggests the scheduler
start by saying, "I need to begin by asking some questions
about your past and present breast health that might seem personal
but will allow me to schedule the appropriate exam."
Second, as suggested by the American College of Radiology (ACR
of Reston, Va), if the facility doesn't offer on-site physical breast
exams, women need to be informed that the physical exam is just
as important as the mammogram. In fact, some recommend a physical
breast exam before the mammo. "Facilities need to inform patients
that mammography is not perfect," Rush explains. "Some
changes are felt only by a primary care physician [PCP]. A clinical
breast exam is an integral part of a breast checkup-as is the self
breast exam; most lumps are found by the patients themselves."
Also, facilities must explain effectively to patients that changes
felt after a mammogram are not to be ignored; the patient should
return to her PCP. "The patient must understand that she is
responsible to be aware," Rush says, "that mammography
isn't perfect, that she needs to work with her PCP, that she needs
to perform self breast exams." In fact, facilities should consider
having a patient sign a form to confirm that she's been told of
and understands her responsibilities.
The responsibility of conveying this information to the patient
falls on both the mammography facility and the referring physician.
Facilities should work on having good relationships with referring
physicians to make sure they are aware of the continuity of care.
"Offer a free lunch to get to know them and form a relationship,"
Rush suggests. "It takes time and effort at the beginning,
but it ensures a smooth workflow and will increase productivity
as the physician refers more patients to the facility. It's a win-win."
Radiologists and breast imagers also need to understand the importance
of a good rapport with the patient. Simply stopping in the patient's
room for 30 seconds to introduce oneself and answer any questions
can make all the difference. Rush cites Peter Dempsey, MD, who claims
that patients almost never sue a radiologist who spoke to them-"even
if the results were not given at the time, or the results turned
out to be incorrect."
Clear communication with patients and referring physicians is a
must and can help reduce your risk of a malpractice claim. Start
implementing these ideas today, and let me know of other strategies
you discover along the way.