Primary care physicians are sued more often than physicians from any other specialty for failing to diagnose coronary heart disease in women.
An analysis by medical liability insurer The Doctors Company found primary care doctors are the defendants in half of such lawsuits, compared with cardiologists in 22% of suits and emergency physicians in 17%. Hospitalists and orthopedists each were sued in 6% of cardiac disease–related legal claims.
The findings are "not surprising," said Dr. George P. Rodgers, cochair of the American College of Cardiology (ACC) Board of Trustees’ work group on medical professional liability insurance.
"Primary care physicians encounter many more problems and many more patients," Dr. Rodgers said. "They’re the front line. They’re the gateway to further evaluation or not."
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Primary care physicians are sued more often than cardiologists, emergency physicians and hospitalists when injuries occur from failing to diagnose coronary heart disease in women.
The Doctors Company examined 41 malpractice claims involving alleged injuries and deaths from cardiac disease in women between 2007 and 2013. The majority of plaintiffs alleged misdiagnosis, followed by problems with medical treatment.
In 83% of cases, inadequate patient assessment was identified as a factor in patients’ injuries. Failure or delay to obtain a consult or referral was a contributing factor in 28% of cases, and documentation problems contributed to 22% of cases.
In more than 80% of suits, patients experienced serious or fatal outcomes.
"The problem is that when we deal with heart disease, the stakes are high," Dr. Rodgers said. "If you miss the diagnosis, it could be a disastrous result."
"Because [women] are more difficult to diagnose, one would suspect that physicians who have less experience and maybe less training are more likely to make errors," according to Dr. Sandeep Mangalmurti, a Chicago cardiologist and attorney.
In some cases, patients have a hand in a delayed or missed cardiac disease diagnosis. The Doctors Company analysis found women patients contributed to their injuries in 11% of cases, while men contributed in 20% of cases. Patient factors centered on noncompliance with treatment plans, medications, and follow-up appointments.
One way to reduce legal risks is to ensure medical information is properly communicated between physicians within the care spectrum, said Dr. Mangalmurti, a member of the ACC Board of Trustees’ work group on medical professional liability insurance. "That’s as important as the actual diagnosis."
In many cases, "the problem isn’t that the doctor made a mistake in practicing medicine, but that the information gets lost in translation," he added.
Obtain a sufficient amount of history from the patient, no matter how specific or nonspecific symptoms may be, advised Robin Diamond, senior vice president of patient safety and risk management for The Doctors Company.
Strong documentation is also key, Ms. Diamond said. Making note of all patient interactions and event timelines can help defend against a potential lawsuit later.
"When a suit is filed, it’s really important that the documentation is present to show that the office took the right steps to make sure the patient was seen quickly," she said.
During medical discussions, Dr. Rodgers recommends that physicians engage not only with the patient, but with family members. In many cases, a patient may disagree with a doctor’s orders, but then does not share the doctor’s recommendations with the family, Dr. Rodgers said. When a poor outcome or death results, the family may blame the physician, which can lead to a lawsuit.
"If there’s one single thing you can do [to reduce liability], it’s that we have to have really good communication with the patient and the family, even when things are going badly," he said. "The patient and the family need to know that you care and that you’re trying everything you can."