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Problems with diagnosis -- failing to make one, making the wrong one, or taking too long to get to one -- lead the list of reasons behind cardiology-related lawsuits, revealed closed claims data from a medical malpractice insurer.

The Doctors Company, a physician-owned insurer, looked at 429 cardiology claims from 2007 to 2013 to compile the list, which can increase awareness among physicians about areas of medicine that carry a high risk of liability, according to , a cardiologist at Bassett Medical Center in Cooperstown, N.Y., who has examined the claims in detail.

"Our goal as cardiologists and as people who are trying to help cardiologists navigate this landscape is to alert them about areas where they're moving into liability danger," Mangalmurti told 乌鸦传媒.

"They should always do the right thing for the patient. I'm never suggesting do something that isn't medically indicated simply for liability reasons," he added. "But we can still be a little bit more educated and savvy about the things that we do every day -- which are the ones that are exposing us to more liability danger."

1. Failure to make a diagnosis, making the wrong diagnosis, or delaying a diagnosis (25%).

The primary issue leading to lawsuits in this category is the failure to diagnose myocardial infarction, Mangalmurti said. Identifying MI can be complicated by the array of presenting symptoms, the sometimes unclear results from the variety of diagnostic tests available, and the presence of other conditions that mimic MI, like aortic dissection.

In addition, many of the claims involved a patient who had a work-up for ischemic heart disease that was normal relatively close to the MI. That can provide a false sense of security to a physician evaluating a patient with MI-related symptoms -- potentially delaying the correct diagnosis -- or make the patient feel as if something had been missed somewhere along the way, even though a normal ischemic work-up does not preclude a later event.

"Management of patient expectations and educating patients as well as physicians about how to correctly diagnose myocardial infarction is an important aspect of risk management," Mangalmurti said.

2. Improper management of treatment (14%).

Mangalmurti said it's difficult to provide a clear definition of what falls into this category, although the main take-away message is that it's important to have a stable practice infrastructure with standardized processes of care.

Examples would include standardized hand-offs of information from doctor to doctor at a shift change, protocols for following up on tests so results don't fall through the cracks, and reliable electronic medical records that capture all of the information needed to make good decisions.

3. and 4. Improper performance of a treatment or procedure (12%) and improper performance of surgery (11%).

"It's inevitable that there are going to be some complications even among the most experienced and most competent operators," Mangalmurti said, noting that the known risks of interventional procedures or operations are discussed with patients during the consent process ahead of time. But that isn't enough to head off a potential lawsuit should one occur.

That's because it's not usually the complication itself that results in a lawsuit, but rather the way it's handled -- or mishandled -- by the physician.

In the case of an interventionalist who suspects a retroperitoneal bleed after a procedure, for example, a lawsuit could be waiting if he or she fails to perform imaging or call in a surgeon to evaluate whether a bleed has actually occurred or fails to treat it.

5. Improper medication management (6%).

"By far, the medications that we need to be aware of as cardiologists from a liability perspective are anticoagulants," Mangalmurti said, noting that the claims are related almost exclusively to bleeding complications.

If placing a patient on systemic anticoagulation -- either with warfarin or one of the newer oral anticoagulants -- "you need to be aware of the fact that you're increasing your liability risk," he said. "You need to [use the treatment] because the patient needs it, but that medication is going to increase your liability exposure, without question."

Another problematic drug is the antiarrhythmic amiodarone, he said, pointing to multiple lawsuits related to side effects like pulmonary fibrosis often seen years after starting treatment.

How to Avoid Lawsuits

Mistakes and complications will happen, and the key to avoiding lawsuits related to those is a solid line of communication between the patient, the patient's family, and the treating physician, according to , co-chair of the American College of Cardiology (ACC) Board of Trustees Work Group on Medical Professional Liability Insurance.

Part of that includes fully informing patients and their families about the potential risks that accompany treatments and procedures, but another part of that includes a sincere effort on the part of the physician to take responsibility for any problems that occur and to try to find solutions, he told 乌鸦传媒. Oftentimes patients and their families will sue because they're frustrated that nobody is owning the situation and providing the answers they need.

"I think we have to acknowledge that no one is perfect, no one is going to get the right diagnosis every time right off the bat, and all of our procedures have complications even in the best of hands and in the most experienced centers, and so those things are going to happen," Rodgers said.

"But the thing that we do have control over as physicians and healthcare providers is the way that we interact with our patients and the families," he said. "And I think that communication can really be the important before the procedure, after the procedure, after the treatment, during the process, the whole thing."

, current president and CEO of the Cardiovascular Research Foundation and former CEO of the American College of Cardiology (ACC), agreed that fully disclosing risks to patients beforehand and owning a complication or mistake from the start can go a long way toward avoiding lawsuits, pointing to the effects of the when something goes wrong as an example.

Other things that might help, Lewin said in an interview, are being "a bit more meticulous" about ruling out other potential diagnoses before settling on one and taking advantage of other members of the healthcare team to provide a second opinion when there is uncertainty.

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