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BREAST CANCER STUDY ... 2002 Breast Cancer Study ..

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BREAST CANCER STUDY ... 2002 Breast Cancer Study ... Document any family history of breast cancer. Document the results of any previous mammograms. ... – PowerPoint PPT presentation

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Title: BREAST CANCER STUDY ... 2002 Breast Cancer Study ..


1
BREAST CANCER STUDY
  • A STUDY OF ISSUES INVOLVING THE DIAGNOSIS OF
    BREAST CANCER THAT RESULT IN MEDICAL MALPRACTICE
    CLAIMS

2
2002 Breast Cancer StudyFocus
  • 450 cases involving paid claims with resolution
    dates no earlier than January 1, 1995 were
    analyzed.
  • The study addresses only claims alleging a delay
    in the diagnosis of breast cancer.
  • 25 PIAA member companies reported information.

3
2002 Breast Cancer StudyMajor Findings
  • More than 68 of the patients represented were
    under the age of 50.
  • These claims account for 78 of reported
    indemnity.
  • The average indemnity payment for claimants under
    50 was 63 higher than for patients 50 and older.
  • Just under 33 of claimants were under 40,
    accounting for 43 of reported indemnity.

4
2002 Breast Cancer StudyMajor Findings
  • The patient most commonly found the lesion (59
    of the cases).
  • A lesion was revealed by a screening or follow-up
    mammogram in 23 of the cases.
  • A physician discovered the lesion in 14 of the
    cases.

5
2002 Breast Cancer StudyMajor Findings
  • Radiologists were cited most frequently as
    defendants. One-third of all paid claims were
    against radiologists.
  • Radiologists are largely involved with the
    diagnosis of breast cancer as at least one
    mammogram was performed in more than 89 of the
    cases.
  • The average indemnity payment for radiologists in
    this study was 337,090.

6
2002 Breast Cancer StudyLeading Reasons for Delay
  • 45 of cases involve a misread mammogram
  • 43 reported that the findings of a physical exam
    failed to impress the provider
  • 40 involved a negative mammogram report
  • 36 failed to make a timely referral
  • 28 involved a communication breakdown between
    providers
  • more than one misadventure per case

7
Presenting Symptom
8
Who Discovered Lesion
9
Physical Findings
10
Initial Diagnosis
11
Comparative Average Indemnity by Claimant Age
12
of Claims and Indemnity by Claimant Age Group
13
Average Delay in Diagnosis by Claimant Age Group
14
of Claims and Indemnity by Severity of Injury
NAIC Severity Code
More Severe
15
Average Severity of Injury by Claimant Age Group
16
Average Patient Age by Severity of Injury
Age
NAIC Severity Code
More Severe
17
Menopausal Status
18
Delay by Patient
No Delay
Delay
19
Average Indemnity for the Period of Delay in
Diagnosis
20
Mammogram Results2002
21
Mammogram Results1995
22
2002 Breast Cancer StudySpecialty Breakdown
23
2002 Breast Cancer StudyPercentage of Claimsby
Physician Specialty
24
Most Common Physician Errors
Communication bet. providers
Failure to refer to specialist
Mammogram report negative
Physical findings did not impress
Mammogram misread
25
Most Common Physician Errors of Errors Per Paid
Defendant
Communication bet. providers
Failure to refer to specialist
Mammogram report negative
Physical findings did not impress
Mammogram misread
26
2002 Breast Cancer StudyComparisons to 1995 Study
  • The average indemnity payment increased 35 from
    301,460 to 407,407. ALAE rose 58 in the same
    time period.
  • Negative or equivocal results in cases where a
    first mammogram remained at 80.
  • The average age of claimants dropped from 46 to
    45, and the median age dropped from 45 to 44.

27
2002 Breast Cancer StudyRecommendations forAll
Practitioners
  • Document all patient complaints regarding the
    breast.
  • Document any family history of breast cancer.
  • Document the results of any previous mammograms.
  • Document the recommendations for subsequent
    diagnostic studies and follow up.

28
2002 Breast Cancer StudyRecommendations forAll
Practitioners
  • Remember to follow up with other physician
    consultants regarding test results etc.
  • A palpable mass with a negative mammogram
    unequivocally requires tissue diagnosis.
  • Pregnancy should not cause delay of appropriate
    diagnostic studies.

29
2002 Breast Cancer StudyRecommendations
forPrimary Care Physicians OB/Gyns
  • Do not abandon diagnostic pursuit because you are
    unimpressed by the physical findings.
  • Perform a thorough breast exam on each female
    patient regardless of age or complaints.
  • If a mass is palpated or suspected, additional
    studies must be done to rule out malignancy.
  • Perform regular follow-up exams on patients who
    present w/ complications of the breast.

30
2002 Breast Cancer StudyRecommendations
forRadiologists
  • Repeat mammograms that result in films of poor
    technical quality.
  • If the mammogram results are equivocal, recommend
    a repeat study, additional views, follow-up
    studies, other imaging modalities etc. as
    appropriate.
  • Be sure an adequate physical exam was performed
    and documented.

31
2002 Breast Cancer StudyRecommendations
forRadiologists
  • Compare the results of any study to all previous
    studies.
  • Promptly report your findings to the referring
    physician or the patient if self-referred. The
    patient should be advised of any abnormality and
    told to consult her GP or OB/Gyn.
  • Make certain a thorough breast exam is done on
    self-referred patients. You are responsible for
    ensuring they receive proper follow-up visits.

32
2002 Breast Cancer StudyRecommendations
forSurgeons
  • Always perform an adequate examination of
    referred patients and document your findings,
    especially when they are unimpressive.
  • Make sure the correct lesion is being removed for
    both open and needle biopsies. Always obtain a
    specimen x-ray.
  • Promptly report consultation and biopsy results
    to referring physician.
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