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 Scott Salter
Expert Review Biases in Radiology Malpractice Cases By Scott Salter
The classic medical malpractice action against a radiologist involves the allegation of a missed radiological finding. Studies have addressed different biases that a radiology expert witness may have when reviewing a medical malpractice action. These biases include “contextual bias,” “hindsight bias,” and “outcome bias” on the medical side. They include “selection bias,” “compensation bias,” and “affiliation bias” on the legal side. Studies have demonstrated that these biases can affect an expert witness’s interpretation of the images during an expert review.1 Cognitive of these potential biases, attorneys should seek to minimize their potential impact on an expert’s review. By minimizing these biases, you can bolster the credibility of the expert witness.
The American College of Radiology has established a Practice Parameter for radiologists serving as expert witnesses in medical malpractice actions.2 The recommended guidelines of conduct provide that the expert witness should strive to minimize all potential sources of conscious and subconscious bias when reviewing case materials. “Images and other relevant material presented in a blinded fashion to the expert in a malpractice lawsuit strengthens the credibility of the opinion rendered by the expert.”
There are a minimum of three biases that a reviewing radiology expert may have based on having access to information that the defendant radiologist did not have. “Contextual bias” arises from the fact that the expert reviewer, even without any other information, knows the review is related to a legal action. This can increase the level of detail and the diagnostic threshold of the reviewer. Second is “hindsight bias.” Hindsight bias is when the expert witness knows the specific finding or alleged “miss” in question. This results in the radiologist, despite his/her best efforts, looking for a specific finding. One study has demonstrated that radiologists were more likely to detect strokes on a CT scan when they had knowledge that an MRI had already shown evidence of a stroke.3
The third medical bias is “outcome bias.” This refers to the reviewing radiologist having knowledge of the patient’s ultimate outcome/injury. This is information
1 Expert Witness Blinding Strategies to Mitigate Bias in Radiology Malpractice Cases: A Comprehensive Review of the Literature, J Am Coll Radiology 2014; 11: 868 – 873.
2 American College of Radiology, Practice Parameter, Expert Witness Radiology and
Radiation Oncology.
3 Impact of Hindsight Bias on Interpretation of Nonenhanced Computed Tomographic Head
Scans for Acute Stroke, Early WK, J. Computer Assisted Tomography 2010; 34:229 – 32.
Healthcare Practice

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