Technical acumen, interpersonal skills influence medicolegal risk

Key Points

Denver - Compared with colleagues in other medical specialties, dermatologists have enjoyed a relatively low risk of being sued for medical malpractice. However, when litigation comes to fruition and is successful, the judgment award to the plaintiff is typically much higher for dermatology cases compared with the national average, says Whitney A. High, M.D., J.D., M.Eng. What's more, dermatopathologists rank second-highest among medical specialists for the number of $1 million-plus verdicts.

Recognizing that issues relating to skin cancer management, including misdiagnosis and other errors, is the leading cause for dermatology- and dermatopathology-related malpractice litigation, there are certain pearls and pitfalls practitioners should heed if they wish to proactively reduce their medicolegal risk, says Dr. High, associate professor and vice chairman (dermatology), departments of dermatology and pathology, University of Colorado School of Medicine, Denver.

According to Dr. High, many malpractice claims involving skin cancer stem from misinterpretation by the dermatopathologist. This information supports advice to be careful in choosing a pathology lab. Dr. High also emphasizes, however, that arriving at a diagnosis involves a multi-step process and numerous professional, technical and clerical personnel, all of which multiply the potential for error.

Having a healthy appreciation for all that's involved in dermatopathology should help physicians and midlevel providers to be more careful in their biopsy techniques, Dr. High says. Although wanting to minimize the size of the specimen obtained is understandable, dermatologists still need to be careful about securing a representative sample to reduce the risk of a missed diagnosis, particularly when performing a punch or shave sampling of a larger process, he explains.

"Many physician extenders have no idea that how the tissue specimen is bisected can affect the diagnostic evaluation and lead to a missed diagnosis or incorrect margin interpretation," Dr. High says.

Citing two recent studies that reported some kind of tissue misidentification that occurred in four of 1,000 specimens, Dr. High also reminds dermatologists to provide as much background information as possible when submitting a biopsy specimen in order to facilitate the dermatopathologist's ability to understand the case, confirm the specimen's identity and arrive at the correct diagnosis.

"Remember that garbage in results in garbage out.," Dr. High says. "It takes just a little extra time to provide some meaningful history, including information on the patient's age, the size, location, and appearance of the lesion, as well as features of the surrounding skin."