To cut their malpractice risks, some urologists have been limiting their practices or referring their most difficult cases.


Now, a new study finds those strategies are useless against one of the most common risks: missed or delayed diagnoses. A survey of 469 successful lawsuits against New York urologists found 15% were based on alleged missed diagnoses. Many of those claims had nothing to do with urology.

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“Historically, urologists have associated high malpractice risk with complex cases and in-hospital care,” the researchers wrote in The Journal of Urology (2007;178:2537-2539). “However, evolving data indicate that office-based urologists may incur significant diagnostic malpractice risk.” 


Led by William J. Badger, MD, a team from Albany Medical College looked at records spanning 20 years from Medical Liability Mutual Insurance Company of New York State. The largest malpractice underwriter in New York, it insures about 400 of the state’s 1,100 urologists.


The data focused only on cases where there was a payout. It did not include cases that were dropped or dismissed or where the urologist won.


Of the 75 missed-diagnosis cases found, 58 arose from urologic conditions, such as testis torsion. Seventy-one percent of the cases were related to cancer. “Identification of cancer is an office-based process in urology, and the diagnostic malpractice risk reported would appear to be highly unavoidable,” the researchers assert.


“Ruling out a urologic condition does not immunize” against malpractice risk, they observe. Seventeen claims involved non-urologic cancers, such as Hodgkin’s lymphoma, or other diseases, including appendicitis and viral encephalitis.


Several previous studies have blamed missed diagnoses on failure to order appropriate tests, failure to create a proper follow-up plan, failure to obtain an adequate history and physical examination, and incorrect interpretation of diagnostic tests, the re-searchers note.


“Failure to diagnose confers a malpractice risk, and it exists in the office setting,” the authors conclude. “It is unlikely that any practicing urologist would be immune to such risk if he or she shows up to work.”