Medical malpractice lawyers have long found diagnostic errors a cause in a significant percentage medical malpractice cases.
Now, a serious study shows that diagnostic errors are a driving force in medical malpractice claims in the US.
If we can better understand why and when medical malpractice occurs, we can focus efforts on reducing the occurrences and the effects of avoidable medical negligence that injure or kill many thousands of people in the United States every year. The Doctors Company, the largest physician-owned medical malpractice insurer in the United States whose unabashed mission is to be “fiercely committed to relentlessly defending, protecting, and rewarding our members with the industry’s most aggressive claims defense, unrivaled protection, and innovative rewards,” recently published the findings of its review of 1,877 medical specialty-specific, diagnosis-related closed claims from 2007 to 2013, focusing on alleged diagnosis-related errors and the specific diagnoses that were involved in the claims involving ten medical specialties. Diagnosis-related medical malpractice claims brought by medical malpractice lawyers and their clients involve allegations of misdiagnosis, delayed diagnosis, failure to diagnose, and other related claims. The review found that 31% of the nonsurgical specialty claims were related to diagnosis (which was the number one allegation in nonsurgical specialty claims) and that 11% of the surgical specialty claims were related to diagnosis, which was the third most common allegation in surgical claims. The review of the closed claims for ten medical specialties during the stated period found the following:
- Of the 1,647 orthopedic claims closed between 2007 and 2013, 13% (215) were diagnosis-related, with the greatest percentage involving the diagnosis of post-operative infection (11.2%) and cancer of the bone and soft tissue (5.6%).
- Of the 1,134 family medicine claims, 37% (417) were diagnosis-related, with the greatest percentage involving the diagnosis of lung cancer (4.3%) and acute MI (4.3%).
- Of the 986 internal medicine claims, 40% (374) were diagnosis-related, with the greatest percentage involving the diagnosis of lung cancer (6.4%) and acute MI (5.6%).
- Of the 885 general surgery claims, 16% (143) were diagnosis-related, with the greatest percentage involving the diagnosis of puncture or laceration during a procedure (15.4%) and breast cancer (9.8%).
- Of the 757 obstetrics claims, 9% (68) were diagnosis-related, with the greatest percentage involving the diagnosis of ectopic pregnancy (17.6%) and postpartum hemorrhage (7.4%).
- Of the 674 gynecology claims, 15% (98) were diagnosis-related, with the greatest percentage involving the diagnosis of breast cancer (21.4%) and puncture or laceration during a procedure (12.2%).
- Of the 447 cardiology claims, 26% (114) were diagnosis-related, with the greatest percentage involving the diagnosis of acute MI (10.5%) and puncture or laceration during a procedure (6.1%).
- Of the 414 emergency medicine claims, 58% (242) were diagnosis-related, with the greatest percentage involving the diagnosis of fracture (13.4%) and acute CVA (13.4%).
- Of the 350 hospital medicine claims, 34% (118) were diagnosis-related, with the greatest percentage involving the diagnosis of acute CVA (8.5%) and acute MI (5.1%).
- Of the 144 pediatrics claims, 61% (88) were diagnosis-related, with the greatest percentage involving the diagnosis of meningitis (8.0%) and pneumonia (4.5%).
- Hence, of the 7,438 closed claims reviewed by The Doctors Company for ten specialties during the period from 2007 to 2013, 1,880 were diagnosis-related.
One reviewer suggests that the primary cause of diagnostic errors is not a lack of knowledge (based on the finding that 52% of the top five diagnosis-related claims in each of the ten medical specialties were repeatedly found in different specialties) but other factors are involved, such as human-factors errors (impaired judgment, fatigue, or distractions); system-related errors due to poor communication or design flaws in electronic health records; failure to follow diagnostic protocols; failure to order appropriate diagnostic tests; failure to create a differential diagnosis; impaired synthesis of diagnostic data from sources such as medical history, physical examination, diagnostic tests, or consultations; narrowly focused diagnoses influenced by a known chronic illness; context errors; and, first-impression or intuition-based diagnoses. The original post appeared here
