Most primary care doctors are sued mainly for missed diagnoses and drug errors, researchers at Royal College of Surgeons in Ireland Medical School and Trinity College Dublin reported in BMJ Open. Most of the missed diagnoses involved cases of meningitis, heart attack and cancer.
The authors, E. Wallace, J. Lowry, S. M. Smith and T. Fahey explained that there have been very few studies on litigation at primary care level. This is surprising, given that most patient visits are with their primary care physician (general practitioner).
The team gathered and analyzed data from published research in English on the number of malpractice claims in primary care in April 2012 and also January 2013. They also wanted to determine the causes of the claims.
After looking through a list of 7,152 studies, they selected 34 which were deemed eligible for their analysis. Fifteen of them were based in the USA, 9 in the UK, seven in Australia, two in France and one in Canada.
The researchers found that:
- 7.8% of claims in April, 2012, and 16% in January, 2013, were against primary care physicians.
- There was a 20% overall increase in claims in the UK between 2009 and 2010, and claims against general practitioners (GPs) made up the greatest proportion of the rise.
- Claims against UK GPs more than doubled between 1994 and 1999.
- In Australia, general practice (primary care) accounted for the highest proportion of claims for both 2009 and 2010 on the Medical Indemnity National Collection database.
- Overall, in the countries studied, missed diagnoses accounted for between 26% and 63% of all malpractice claims.
- Death was the most common consequence of alleged malpractice, ranging from 15% to 48% of all claims made for missed diagnoses.
- In the claims made, the most commonly missed diagnoses were related to heart attack and cancer among adults. There were many claims alleging missed diagnoses in cases of fractures, ectopic pregnancy, and appendicitis.
- The most common claims among pediatric patients were related to cancers and meningitis.
- Drug errors were the second most common sources of malpractice claims, which ranged from 5.6% to 20% of all cases.
Most claims were unsuccessful
In the United States just one third of claims ended up in a pay-out; and nearly half in the UK.
Over the last twenty years, the number of malpractice claims brought against American primary care physicians has not changed significantly. This has not been the case in the UK and Australian, where claims against GPs have been steadily rising.
The term "primary care" has slightly different meanings from one country to another, making it hard to generalize from these findings, the authors acknowledged. "Using legal claims as a proxy for adverse events also has its limitations", they added.
In an Abstract in the journal, the authors concluded:
"This review of malpractice claims in primary care highlights diagnosis and medication error as areas to be prioritised in developing educational strategies and risk management systems"
Blood thinners make up 7% of all medication errors - researchers from the University of Illinois reported in Annals of Pharmacotherapy that approximately 7% of all medication errors in hospitalized patients in the USA involve anticoagulant drugs, also known as blood thinners. Blood thinners are prescribed to reduce the risk of stroke and heart attack by preventing blood clots in the veins and arteries.
10% of medical career time waiting for malpractice claim resolutions - the average doctor in the USA spends about 10% of his/her time in practice waiting for a malpractice claim to be resolved, Seth Seabury, from the RAND Corporation, and Anupam Jena, from Harvard Medical School, reported in the journal Health Affairs.
Professor Jena said "We believe that the time required to resolve malpractice claims may be a significant reason that physicians are so vocal about malpractice reform, and that any attempt at malpractice reform will need to take the speed with which cases are resolved into account."