title: Expert witness blinding strategies to mitigate bias in radiology malpractice cases: a comprehensive review of the literature.
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.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland. Electronic address: Daniel.J.Durand@gmail.com.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Durand
authors.affiliation: Harvard Law School, Cambridge, Massachusetts.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Robertson
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Gautam
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
authors.affiliation: Department of Medical Imaging, University of Arizona, Tucson, Arizona.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Krupinski
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jason N
authors.initials: JN
authors.lastname: Itri
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fotenos
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Brent
authors.initials: B
authors.lastname: Savoie
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ding
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Lewin
mesh_terms: D005104:Expert Testimony; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D010380:Peer Review; D011361:Professional Competence; D011871:Radiology / Q000331:legislation & jurisprudence*; D014481:United States
keywords: Observer performance; blinded peer review; expert-witness blinding; medical malpractice; observer bias