Q&A with Leonard Berlin, MD: Errors, quality and malpractice

year and down another 10% or 12% from the previous year. The reason is probably economic. In the United States, we work on a contingency basis. The plaintiff’s attorney has to lay out the money and the patient pays nothing. The economics are such today that court costs are high and expert witnesses are expensive, so lawyers are very careful. Unless they see a chance for a reasonable return on their investment, they are not going to take a case.

So, although the number of cases is down, one of the concerns there is electronic medical records. EMRs are increasing errors, as is widely known, and the concern is that we will see more malpractice suits because of EMRs. They are supposed to diminish errors, and they are increasing errors. There’s a lot of duplication. Once something is in a medical record, it’s there forever—and if it’s not in there, it doesn’t become part of the patient history. We cut and paste, so that error keeps getting repeated.

In radiology, mammography is still the most common modality for which radiologists are sued for missing diagnoses.

MIR: How can radiology practices minimize their error rates?

Berlin: We have to compare with previous diagnostic studies. We have to take adequate time to interpret an individual study. We should try to obtain as much patient history as possible. The other issue is not only making the diagnosis but also communicating the diagnosis.

We have seen an increase in malpractice suits because a significant unexpected finding has not been properly communicated to the referring physician. Radiologists have to communicate directly to referring physicians when we see a significant unexpected finding. Too often, it’s the case that the abnormality was in the report, but it wasn’t sufficiently well communicated.

MIR: It’s interesting that, despite all the focus we’ve seen on improving quality—all the financial incentive and penalty systems, all the reporting requirements—combined with the tremendous advances in technology, we aren’t seeing error rates nosediving.  

Berlin: We’re all human. We’re always going to make errors, and technology only goes so far. We still have the human brain to deal with here. I would love to say errors are way down. Well, thanks to the EMR, they’re not way down. But we have to keep errors in perspective. Medical care is better than ever. And most of the errors that are labeled errors do not injure patients. Every so often a patient does get harmed, and then we have to compensate the patient and take care of it. But not every error is bad. We make errors, and we should learn from our errors—which we all continue to do.