FAQs

FAQs About Diagnosis

  • Does a self-discovered lump that cannot be detected by a clinician require follow-up?

    Yes. A self-discovered lump should be followed to resolution even if there is provider-patient discordance on the presence of the lump. Follow every mass to conclusion.

    For more information view: CRICO/RMF's Breast Care Management Algorithm

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  • What do I tell a breast care patient who is unsatisfied with a negative finding?

    Discuss options with your patient and include her in management decisions. Elicit and heed all complaints and investigate abnormal symptoms aggressively. Develop a clear and effective plan and insure the patient's understanding and agreement of that plan.

    Document all interactions as they occur to support future care and to clarify any disputes that may arise later. This includes:

    • In the history and physicals section of the record include the findings of the breast examination. Note--in quotes--what the patient said versus your own findings.
    • Use a diagram or descriptive notes to record the exact location of all lumps or lesions.

    For more information view: CRICO/RMF's Breast Care Management Algorithm

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  • What communication practices can help reduce allegations of a failure to diagnose breast cancer?

    • Avoid sending the wrong message to a patient by just telling her that a palpable lump is probably benign. Stress that additional studies may be needed to rule out malignancy.
    • Share any uncertainty with the patient in a way that helps them appreciate the importance of follow-up appointments.
    • Confirm and document with other providers which of you will be the clinician of record and responsible for ordering tests and following up with the patient.
    • Communicate all abnormal findings to the patient and document that act.

    For more information view: CRICO/RMF's Breast Care Management Algorithm

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  • What patient follow-up practices can help reduce allegations of a failure to diagnose breast cancer?

    • Make follow-up or test appointments before the patient leaves your office.
    • Create a system to recall and track patients who need follow-up. Without a tracking system to ensure that the patient actually returns to the office or for additional testing, a note in the record that a patient needs to be followed is insufficient.
    • Contact patients a day or two before their appointments to reduce noncompliance.
    • Ask the radiology department or specialist to notify your office of patients who do not keep scheduled appointments.
    • Document all patient no-shows or cancellations in the medical record.
    • Note patient refusals in the record with an explanation that the risks of not having a recommended diagnostic test or procedure were explained. Consider using an informed refusal form signed by the patient.
    • Track all surgical referrals to ensure that you are receiving a timely report from the surgeon.

    For more information view: CRICO/RMF's Breast Care Management Algorithm

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  • What practices around receiving and reporting test results can help reduce allegations of a failure to diagnose breast cancer?

    • Provide pertinent clinical information for the radiologist on the mammography request form.
    • Request that all abnormal findings be communicated directly by the radiologist or pathologist to the clinician of record.
    • Document telephone conversations regarding the reported results.
    • Review and sign all test results before they are filed in the record.
    • Create a system to track ordered tests and outside referrals to ensure notification of test results and referral outcomes.
    • Request written copies of all results, including those conveyed orally.

    For more information view: CRICO/RMF's Breast Care Management Algorithm

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  • What documentation practices can help reduce allegations of a failure to diagnose breast cancer?

    • Document a thorough breast examination in the history and physical examination; enter, in quotes, the patient's breast complaints and what she says.
    • Use a diagram (or descriptive notes) to record the exact location of all lesions.
    • In the event that a patient's breast care is being managed by another clinician, document the date of the patient's last exam to ensure that subsequent exams are performed when appropriate.
    • During each visit, update the patient's risk factor assessment and your recommendations for screening based on their current risk for developing breast cancer.
    • Consider using a problem list to highlight patients with a positive family history of breast cancer.

    For more information view: CRICO/RMF's Breast Care Management Algorithm

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  • What common assumptions can increase the risk of an allegation of a failure to diagnose breast cancer?

    • All patients share similar risk.
    • Younger women with breast complaints are not at potential risk for developing breast cancer.
    • Patients will volunteer to update personal and family histories without prompting.
    • All tests will be performed as requested.
    • All tests will be adequately interpreted.
    • Laboratory personnel and specialists will always relay relevant findings directly to the primary care provider (PCP) or patients.
    • Negative imaging in the picture of a breast mass, lump, or thickening is the end of a workup.
    • Visits to specialists are always conducted as requested.
    • Patients always understand the varying roles of the PCP, the Radiology staff, and breast specialists.
    • The specialist will adequately coordinate the diagnostic care and communication with the patient around need for follow-up.

    For more information view: CRICO/RMF's Breast Care Management Algorithm

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