Disclosing harmful mammography errors to patients.
OBJECTIVE
To assess radiologists' attitudes about disclosing errors to patients by using a survey with a vignette involving an error interpreting a patient's mammogram, leading to a delayed cancer diagnosis.


METHODS
We conducted an institutional review board-approved survey of 364 radiologists at seven geographically distinct Breast Cancer Surveillance Consortium sites that interpreted mammograms from 2005 to 2006. Radiologists received a vignette in which comparison screening mammograms were placed in the wrong order, leading a radiologist to conclude calcifications were decreasing in number when they were actually increasing, delaying a cancer diagnosis. Radiologists were asked (a) how likely they would be to disclose this error, (b) what information they would share, and (c) their malpractice attitudes and experiences.


RESULTS
Two hundred forty-three (67%) of 364 radiologists responded to the disclosure vignette questions. Radiologists' responses to whether they would disclose the error included "definitely not" (9%), "only if asked by the patient" (51%), "probably" (26%), and "definitely" (14%). Regarding information they would disclose, 24% would "not say anything further to the patient," 31% would tell the patient that "the calcifications are larger and are now suspicious for cancer," 30% would state "the calcifications may have increased on your last mammogram, but their appearance was not as worrisome as it is now," and 15% would tell the patient "an error occurred during the interpretation of your last mammogram, and the calcifications had actually increased in number, not decreased." Radiologists' malpractice experiences were not consistently associated with their disclosure responses.


CONCLUSIONS
Many radiologists report reluctance to disclose a hypothetical mammography error that delayed a cancer diagnosis. Strategies should be developed to increase radiologists' comfort communicating with patients.
Gallagher
Thomas H
TH
Department of Medicine, and Division of General Internal Medicine, University of Washington, 4311 11th Ave NE, Suite 230, Seattle, WA 98105, USA. thomasg@u.washington.edu
Cook
Andrea J
AJ
Brenner
R James
RJ
Carney
Patricia A
PA
Miglioretti
Diana L
DL
Geller
Berta M
BM
Kerlikowske
Karla
K
Onega
Tracy L
TL
Rosenberg
Robert D
RD
Yankaskas
Bonnie C
BC
Lehman
Constance D
CD
Elmore
Joann G
JG
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003142:Communication; D003625:Data Collection; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008318:Malpractice; D008327:Mammography; D008875:Middle Aged; D010817:Physician-Patient Relations; D011871:Radiology; D014342:Truth Disclosure