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Review highlights financial impact of sarcoma misdiagnosis

December 6, 2016

Malpractice awards and settlements are eight times greater when physicians misdiagnose sarcoma than when they make other mistakes, according to a review of 32 years of court cases. For orthopaedic surgeons, the indemnity payments were 17 times higher. However, primary care physicians were more apt to be sued.

The review is the latest effort by Ginger Holt, M.D., Jennifer Halpern, M.D., and Herbert Schwartz, M.D., of the Vanderbilt Sarcoma Center, to reverse a longstanding trend of delayed referrals for the rare cancer.

Previously, the group looked at the distances patients lived from sarcoma centers and whether patients had health insurance. Neither proved to be a significant factor so they shifted their focus to physicians. That line of inquiry has included medical school training, payment models and misdiagnoses.

“Why today do these patients still get mishandled?” Holt said. “How can it be that when a patient presents with a lump or a bump, they may be treated the same as they were in 1970? The same numbers: one out of every three patients we see in clinic has had an inappropriately excised tumor.”

Physicians commonly misdiagnose sarcomas as lipomas, a benign fatty mass that’s usually harmless.

An MRI scan can show distinctions between the two that a CT scan can’t. Even with an accurate diagnosis, surgeons who don’t specialize in sarcoma treatment often fail to remove all the affected tissue.

New imaging technology developed at Vanderbilt University allows Sarcoma Center surgeons to better determine the margins of sarcoma cells. Holt, who is one of the inventors of that technology, lectured about it at the Musculoskeletal Tumor Society conference in October 2015.

But getting primary care physicians to recognize the problem of misdiagnosed cases and delayed referrals remains a struggle. That’s why the physicians teamed up with lawyers to do a LexisNexis review of malpractice cases for the study, which was published in Journal of Surgical Oncology.

“Our conclusions were very different than what I thought they were going to be,” Holt said. “I thought surgeons were going to be sued left and right. Surprisingly, it was the primary care doctors that people were really unhappy with.”

The average amount for verdicts and settlements went as high as $4 million and $5.5 million in some states.

The Vanderbilt team doing the legal review determined that basic sarcoma recognition education should be part of the standardized curriculum within medical schools.

They also urged interaction between the professional societies representing sarcoma specialists and primary care physicians.