Almost one in ten radiologists wouldn't tell patients if an interpretation error led to a delayed cancer diagnosis, according to an article published this month in Radiology.

Researchers, headed by Thomas Gallagher, M.D. at the University of Washington, queried 364 radiologists at seven clinics participating in the Breast Cancer Surveillance Consortium about their willingness to admit to an error that could lead to a lag in detecting breast cancer.

The radiologists first heard a hypothetical scenario involving reading mammograms in the wrong order -- where it appeared a suspicious shadow in the breast was disappearing, rather than growing. Then, they responded to a survey that asked them what they would tell the patient about the goof.

About 9 percent of radiologists said they would "definitely not" tell the patient of the error, with around 51 percent saying they would only mention it if asked by the patient. Around 40 percent said they were likely or certain to disclose the mistake, no matter what.

But even though many radiologists would own up to the error, most wouldn't disclose much about it. Among all radiologists surveyed, only 15 percent would say, "An error occurred during the interpretation of your last mammogram, and the calcifications had actually increased in number, not decreased," with the majority either keeping mum about what exactly happened or opting to only say a few words about how the shadows were growing before, but only now look "worrisome."

Only hypothetical?

Still, the test was not a review of actual medical practice, only of the responses of radiologists asked to consider an imaginary episode. So, how robust is the link between self-reports on a hypothetical scenario and real-life behavior in the clinic?

"The link is relatively close, though not perfect," Dr. Gallagher tells DOTmed News. For instance, he mentions a study that compared doctors' answers to a hypothetical survey and their interactions with an actor pretending to be a patient, with a review of their medical records. The study found a close, if not exact, match among the three.

Malpractice experience

So why would so many radiologists be reluctant to disclose errors? Dr. Gallagher and the other authors argue that, somewhat surprisingly, having been sued for malpractice didn't perfectly correlate with reluctance to disclose.

In fact, in an article about medical errors published this summer in the Journal of American Medicine, which Dr. Gallagher also wrote, he suggests that contrary to long-held medical wisdom, in which doctors are afraid to disclose errors for fear of it counting as an admission of guilt, apologizing to patients often results in "fewer lawsuits and lower legal expenses," as surveys suggest patients can be less reluctant to sue after receiving a timely acknowledgment of error.

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