Dr. Raskin is the Internal Legal Counsel for the Florida Radiological Society, and a Voluntary Associate Professor of Radiology, University of Miami School of Medicine, MIami, FL and a Radiologist at University Medical Center, Tamarac, FL. He is also a member of the Editorial Board of this journal.

A very practical reason for studying risk management is to attempt to understand why radiologists get sued. The risk of being sued is quite high in all areas of medicine, not just radiology. This risk cannot be eliminated. However, there are some positive risk-management steps that radiologists can take to reduce their chance of being sued and losing. The more you understand the risk-management process, the better you will be able to minimize or manage your risk. Risk management involves the identification, analysis, and evaluation of risk and selection of the most advantageous method to address it. From a practical standpoint, this means identifying situations in which you are at the greatest risk of being sued and then doing something to minimize that risk.

The first step of the risk-management process involves identification of the risk. This may vary depending upon the practice. Certain areas of radiology practice are associated with a significantly higher incidence of lawsuits in which risk management techniques can be effective in reducing the risk of being sued and losing. The most commonly missed diagnoses are breast cancer, lung cancer, and fracture of the spine, in that order. Clearly, risks are greatest in these areas.

Once the risk is identified, it must be analyzed. Do the lawsuits occur with certain radiologists, during the evening, or during teleradiology reads? Is there a trend? Once the risk is analyzed, implementation of risk-management techniques should be instituted. Some techniques that have been shown to be effective are: (1) paying attention to clinical information or obtaining it when not given; (2) being qualified to interpret or perform a procedure and maintaining your competence; (3) suggesting the next appropriate study or procedure, recognizing that a follow-up study may be the next appropriate procedure; (4) using the American College of Radiology (ACR) Appropriateness Criteria; (5) directly communicating, in person or by telephone, the findings when immediate patient treatment is indicated and documenting the communication; and (6) reading, understanding, and implementing the ACR Practice Guidelines and Technical Standards into your practice.

Finally, there must be a method to monitor the results. If not, you won't know whether or not any of the changes you made were effective. Certainly, implementing these risk-management techniques will not prevent you from being sued. They will, however, reduce the risk of being sued and losing.