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 R!F"s #reast Care !ana$ement Al$orithm #ac% to &op

What do I tell a breast care patient who is unsatisfied with a negative finding?
'iscuss options with your patient and include her in mana$ement decisions. (licit and heed all complaints and investi$ate abnormal symptoms a$$ressively. 'evelop a clear and effective plan and insure the patient"s understandin$ and a$reement of that plan. 'ocument all interactions as they occur to support future care and to clarify any disputes that may arise later. &his includes: In the history and physicals section of the record include the findin$s of the breast e)amination. *ote--in +uotes--what the patient said versus your own findin$s. ,se a dia$ram or descriptive notes to record the e)act location of all lumps or lesions. For more information view: CRICO R!F"s #reast Care !ana$ement Al$orithm #ac% to &op

What communication practices can help reduce allegations of a failure to diagnose breast cancer?
Avoid sendin$ the wron$ messa$e to a patient by -ust tellin$ her that a palpable lump is probably beni$n. .tress that additional studies may be needed to rule out mali$nancy. .hare 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 orderin$ tests and followin$ up with the patient. Communicate all abnormal findin$s to the patient and document that act. For more information view: CRICO R!F"s #reast Care !ana$ement Al$orithm #ac% to &op

What patient follow-up practices can help reduce allegations of a failure to diagnose breast cancer?
!a%e follow-up or test appointments before the patient leaves your office. Create a system to recall and trac% patients who need follow-up. /ithout a trac%in$ system to ensure that the patient actually returns to the office or for additional testin$0 a note in the record that a patient needs to be followed is insufficient. Contact patients a day or two before their appointments to reduce noncompliance. As% the radiolo$y department or specialist to notify your office of patients who do not %eep scheduled appointments. 'ocument all patient no-shows or cancellations in the medical record. *ote patient refusals in the record with an e)planation that the ris%s of not havin$ a recommended dia$nostic test or procedure were e)plained. Consider usin$ an informed refusal form si$ned by the patient. &rac% all sur$ical referrals to ensure that you are receivin$ a timely report from the sur$eon. For more information view: CRICO R!F"s #reast Care !ana$ement Al$orithm #ac% to &op

What practices around receiving and reporting test results can help reduce allegations of a failure to diagnose breast cancer?
1rovide pertinent clinical information for the radiolo$ist on the mammo$raphy re+uest form. Re+uest that all abnormal findin$s be communicated directly by the radiolo$ist or patholo$ist to the clinician of record. 'ocument telephone conversations re$ardin$ the reported results. Review and si$n all test results before they are filed in the record. Create a system to trac% ordered tests and outside referrals to ensure notification of test results and referral outcomes. Re+uest written copies of all results0 includin$ those conveyed orally. For more information view: CRICO R!F"s #reast Care !ana$ement Al$orithm #ac% to &op

What documentation practices can help reduce allegations of a failure to diagnose breast cancer?
'ocument a thorou$h breast e)amination in the history and physical e)amination2 enter0 in +uotes0 the patient"s breast complaints and what she says. ,se a dia$ram 3or descriptive notes4 to record the e)act location of all lesions. In the event that a patient"s breast care is bein$ mana$ed by another clinician0 document the date of the patient"s last e)am to ensure that subse+uent e)ams are performed when appropriate. 'urin$ each visit0 update the patient"s ris% factor assessment and your recommendations for screenin$ based on their current ris% for developin$ breast cancer. Consider usin$ a problem list to hi$hli$ht patients with a positive family history of breast cancer. For more information view: CRICO R!F"s #reast Care !ana$ement Al$orithm #ac% to &op

What common assumptions can increase the risk of an allegation of a failure to diagnose breast cancer?
All patients share similar ris%. Youn$er women with breast complaints are not at potential ris% for developin$ breast cancer. 1atients will volunteer to update personal and family histories without promptin$. All tests will be performed as re+uested. All tests will be ade+uately interpreted. 5aboratory personnel and specialists will always relay relevant findin$s directly to the primary care provider 31C14 or patients. *e$ative ima$in$ in the picture of a breast mass0 lump0 or thic%enin$ is the end of a wor%up. 6isits to specialists are always conducted as re+uested. 1atients always understand the varyin$ roles of the 1C10 the Radiolo$y staff0 and breast specialists. &he specialist will ade+uately coordinate the dia$nostic care and communication with the patient around need for follow-up.