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Article: Medicolegal affairs. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial

TitleMedicolegal affairs. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial
Authors
Issue Date1998
PublisherScience Printers and Publishers, Inc. The Journal's web site is located at http://www.acta-cytol.com
Citation
Acta Cytologica, 1998, v. 42 n. 1, p. 76-119, discussion p. 120-132 How to Cite?
AbstractISSUES: Increasing litigation over alleged false negative cervical cytologic (CC) smears threatens the viability of this test for cervical cancer detection. The problem appears to be largely American but is beginning to appear in some other countries. In the vast majority of cases there is either a settlement or jury verdict for the plaintiff based largely on the testimony of expert witnesses. Cases are judged on an individual basis without significant consideration of the general performance of the CC smear in laboratories operating in compliance with a wide array of laboratory regulations and with documented and comprehensive quality control practices in place. It is acknowledged that there are problem laboratories and cytology practitioners. There is an emerging issue of automated preparation and screening devices and issues of informed patient consent. CONSENSUS POSITION: Cytology professionals have done an extraordinary and commendable job of educating the public about the benefits of the CC smear. We have been less successful and conscientious about explaining and defining the limitations of the CC test. There is a need for public and professional education as to the benefits and limitations of the CC smear for cervical cancer detection. The process suggested is to work with women's groups, public health agencies, government agencies, and state and national legislatures and to coordinate professional committees working on liability issues. Contextual information could be included with the CC smear report to indicate that a negative report confers a low probability of developing cervical cancer. It is suggested that appropriate language and a menu of statements be developed. Increased efforts should be directed to physician education with respect to informed consent concerning the benefits and limitations of CC smear testing and the application of new technology to improve smear accuracy. The process should include development of appropriate statements on the use of alternative technology. The profession should develop "process guidelines" for review of CC smears in the context of possible litigation, including standardized methods for blind slide review of smears that reduce or eliminate context and outcome bias. It is suggested that review panels be anonymous, that the process be standardized and that there be limitations on liability for participating organizations. Professional cytopathology and pathology societies should formulate acceptable guidelines for expert witnesses. The standards should be applicable to both defendant and plaintiff experts. All materials to the extent practical, including consultant opinions, should be available for peer review. Professional cytopathology and pathology societies should monitor expert testimony for objectivity and scientific accuracy. ONGOING ISSUES: For the near future, litigation will continue to focus on false negative CC smears on a case-by-case basis. Laboratories and individuals can reduce the risk of malpractice liability by directing their attention to proactive quality control and quality assurance methods. In the final analysis, consumer education about the benefits and limitations of the test is key to limiting malpractice claims. To stem the tide of continued medicolegal challenges to the integrity of cytology practice, the cytology community has now focused its efforts on developing and utilizing standards that convey to patients, attorneys and cytologists the contemporary status of and reasonable expectations for the practice of cytology. Guidelines such as those for uniform reporting terminology and clinical management of cervical abnormalities form the basis of cytology practice standards on which legal standards of practice can be based. Consensus conference reports, clinical management trials and scientifically valid studies of false negative rates that analyze the type, frequency and cause of missed cases represent sounder methods of establishing defensible practice standards than do anecdotal reports or opinions.
Persistent Identifierhttp://hdl.handle.net/10722/148101
ISSN
2013 Impact Factor: 1.562
2015 SCImago Journal Rankings: 0.486
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorFrable, WJen_US
dc.contributor.authorAustin, RMen_US
dc.contributor.authorGreening, SEen_US
dc.contributor.authorCollins, RJen_US
dc.contributor.authorHillman, RLen_US
dc.contributor.authorKobler, TPen_US
dc.contributor.authorKoss, LGen_US
dc.contributor.authorMitchell, Hen_US
dc.contributor.authorPerey, Ren_US
dc.contributor.authorRosenthal, DLen_US
dc.contributor.authorSidoti, MSen_US
dc.contributor.authorSomrak, TMen_US
dc.date.accessioned2012-05-29T06:10:51Z-
dc.date.available2012-05-29T06:10:51Z-
dc.date.issued1998en_US
dc.identifier.citationActa Cytologica, 1998, v. 42 n. 1, p. 76-119, discussion p. 120-132en_US
dc.identifier.issn0001-5547en_US
dc.identifier.urihttp://hdl.handle.net/10722/148101-
dc.description.abstractISSUES: Increasing litigation over alleged false negative cervical cytologic (CC) smears threatens the viability of this test for cervical cancer detection. The problem appears to be largely American but is beginning to appear in some other countries. In the vast majority of cases there is either a settlement or jury verdict for the plaintiff based largely on the testimony of expert witnesses. Cases are judged on an individual basis without significant consideration of the general performance of the CC smear in laboratories operating in compliance with a wide array of laboratory regulations and with documented and comprehensive quality control practices in place. It is acknowledged that there are problem laboratories and cytology practitioners. There is an emerging issue of automated preparation and screening devices and issues of informed patient consent. CONSENSUS POSITION: Cytology professionals have done an extraordinary and commendable job of educating the public about the benefits of the CC smear. We have been less successful and conscientious about explaining and defining the limitations of the CC test. There is a need for public and professional education as to the benefits and limitations of the CC smear for cervical cancer detection. The process suggested is to work with women's groups, public health agencies, government agencies, and state and national legislatures and to coordinate professional committees working on liability issues. Contextual information could be included with the CC smear report to indicate that a negative report confers a low probability of developing cervical cancer. It is suggested that appropriate language and a menu of statements be developed. Increased efforts should be directed to physician education with respect to informed consent concerning the benefits and limitations of CC smear testing and the application of new technology to improve smear accuracy. The process should include development of appropriate statements on the use of alternative technology. The profession should develop "process guidelines" for review of CC smears in the context of possible litigation, including standardized methods for blind slide review of smears that reduce or eliminate context and outcome bias. It is suggested that review panels be anonymous, that the process be standardized and that there be limitations on liability for participating organizations. Professional cytopathology and pathology societies should formulate acceptable guidelines for expert witnesses. The standards should be applicable to both defendant and plaintiff experts. All materials to the extent practical, including consultant opinions, should be available for peer review. Professional cytopathology and pathology societies should monitor expert testimony for objectivity and scientific accuracy. ONGOING ISSUES: For the near future, litigation will continue to focus on false negative CC smears on a case-by-case basis. Laboratories and individuals can reduce the risk of malpractice liability by directing their attention to proactive quality control and quality assurance methods. In the final analysis, consumer education about the benefits and limitations of the test is key to limiting malpractice claims. To stem the tide of continued medicolegal challenges to the integrity of cytology practice, the cytology community has now focused its efforts on developing and utilizing standards that convey to patients, attorneys and cytologists the contemporary status of and reasonable expectations for the practice of cytology. Guidelines such as those for uniform reporting terminology and clinical management of cervical abnormalities form the basis of cytology practice standards on which legal standards of practice can be based. Consensus conference reports, clinical management trials and scientifically valid studies of false negative rates that analyze the type, frequency and cause of missed cases represent sounder methods of establishing defensible practice standards than do anecdotal reports or opinions.en_US
dc.languageengen_US
dc.publisherScience Printers and Publishers, Inc. The Journal's web site is located at http://www.acta-cytol.comen_US
dc.relation.ispartofActa Cytologicaen_US
dc.subject.meshCell Biology - Legislation & Jurisprudenceen_US
dc.subject.meshConfidentialityen_US
dc.subject.meshDefensive Medicineen_US
dc.subject.meshDiagnostic Errorsen_US
dc.subject.meshDisease Progressionen_US
dc.subject.meshExpert Testimonyen_US
dc.subject.meshFalse Negative Reactionsen_US
dc.subject.meshFemaleen_US
dc.subject.meshHealth Educationen_US
dc.subject.meshHumansen_US
dc.subject.meshInsurance, Liabilityen_US
dc.subject.meshJurisprudenceen_US
dc.subject.meshMalpracticeen_US
dc.subject.meshMass Screening - Legislation & Jurisprudenceen_US
dc.subject.meshMedical History Takingen_US
dc.subject.meshObserver Variationen_US
dc.subject.meshPatient Advocacyen_US
dc.subject.meshPredictive Value Of Testsen_US
dc.subject.meshProfessional Practice - Standardsen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshSingle-Blind Methoden_US
dc.subject.meshTruth Disclosureen_US
dc.subject.meshUnited Statesen_US
dc.subject.meshUterine Cervical Diseases - Classification - Diagnosis - Pathologyen_US
dc.subject.meshUterine Cervical Neoplasms - Diagnosis - Prevention & Controlen_US
dc.subject.meshVaginal Smearsen_US
dc.titleMedicolegal affairs. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorialen_US
dc.typeArticleen_US
dc.identifier.emailCollins, RJ: rcollins@hkucc.hku.hken_US
dc.identifier.authorityCollins, RJ=rp00251en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid9479326-
dc.identifier.scopuseid_2-s2.0-0031613238en_US
dc.identifier.volume42en_US
dc.identifier.issue1en_US
dc.identifier.spage76en_US
dc.identifier.epage119en_US
dc.identifier.isiWOS:000072224800009-
dc.publisher.placeUnited Statesen_US

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