Northwest Physicians Insurance Company
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Risk Management Tip |
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PSA
Testing Earlier this year, NPM devoted a Risk Management Tip to the subject of PSA monitoring. Given the controversy that surrounds the subject of PSA testing, a number of you called or wrote asking us to restate our position regarding this matter. This Risk Management Tip seeks to clarify what we believe to be important from a risk management perspective when it comes to PSA testing. The issue is as follows: NPM is seeing a disturbing increase in the number of claims associated with a delay in diagnosis of prostate cancer. Most of these claims have several significant factors in common. They involve changing PSA test values where the physician takes no action, i.e. increasing PSA levels to indisputable abnormal limits without appropriate follow up or referral being initiated. Changing PSA test results had been charted but were either missed or not acted upon in a timely manner. In several instances system failures such as laboratory reports being filed in the chart without the physician seeing the results were also contributing factors to the claim. As you are undoubtedly aware, differing recommendations exist when it comes to performing PSA testing. When screening for prostate cancer, the American Urologic Association and the American Cancer Society recommend routine annual rectal exams and PSA's for men over the age of 50. Where a positive family history of prostate cancer is present (or individuals are of African American descent) screening is recommended at age 40. Other organizations, i.e. The Center for Disease Control (CDC), have their own recommendations. The American Academy of Family Physicians and the National Cancer Institute do not recommend routine PSA testing for prostate cancer but encourage discussion of the benefits and limitations of the test. NPM TAKES NO POSITION WHEN IT COMES TO RECOMMENDING ROUTINE PSA TESTING. However, we wish to stress the importance of recognizing and dealing with changing PSA results IF you and your patient decide to test. When you discuss PSA testing with your patients make certain that the PAR (procedure-alternatives-risks) discussion is thorough. It is important to carefully document the key discussion and decision points that were mutually agreed upon. New variations such as age adjusted PSA's, PSA velocity, total and Free PSA may also be used to determine normal and abnormal values. These may be important considerations in deciding what is most appropriate for your patients. Whatever you and your patient decide, make certain the discussion and decisions reached are adequately documented. In those instances where PSA testing is performed, be certain to follow-up abnormal test results in a timely manner with thorough treatment plan discussions held with the patient; repeat testing where indicated and initiate referrals as appropriate.
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