The majority of lawsuits against internists stem from alleged diagnostics errors, results of a new study show.
Of 1,180 legal claims against internists, 39% were related to failed, delayed, or wrong diagnosis allegations, according to an analysis published by The Doctors Company, a nationwide medical malpractice insurer. Negligence associated with medical treatment accounted for 32% of the claims, while 19% were related to alleged medication errors.
The Doctors Company evaluated 1,180 claims from its database against internal medicine physicians that closed from 2007 to 2014. Of diagnostic-related cases, 56% alleged inadequate patient assessments, such as failure to order or delay in ordering diagnostic tests. The final diagnoses most commonly related to these allegations were myocardial infarction (6%), lung cancer (5%), and colorectal cancer (5%). More than 200 other diagnoses were seen in fewer than 2% of the claims, according to the study.
Dr. David Troxel
In cases that involved injury, a top contributing factor was patient assessment issues, such as failure to establish a differential diagnosis or inadequate assessment. Patient factors, such as noncompliance, were also a primary contributer to injuries. The third most common factor for injury was poor communication among providers, family, and patients, such as inadequate education about the risks of medications.
The findings hopefully will assist internists and risk managers in understanding common allegations and factors behind lawsuits so that improvements can be made, study coauthor David B. Troxel, MD, medical director for The Doctors Company said in a statement.
“With the data on patient allegations and the actual factors that led to injuries included in this study, physicians and risk managers can identify system weaknesses and reduce risk of harm to patients,” he said.
Dr. Howard Marcus
“Physicians, internists, would benefit from something we’re doing in my group where we talk about why it is that there are cognitive errors,” he said. “Is there a system problem here, rather than someone who just made a mistake?”
Dr. Marcus advised physicians to read a recent report by the National Academies of Sciences, Engineering, and Medicine, which calls for more emphasis on identifying and learning from diagnostic errors and near misses in clinical practice, a payment and care delivery environment that supports the diagnostic process, and a dedicated focus on new research.
Ensuring that patients understand the treatment plan and follow-up care management are also key risk mitigation steps, adds Dr. Troxel.
“Patient compliance is a major problem,” he said in an interview. “It’s not that patients are not listening to the doctor. Sometimes they don’t understand what the doctor is explaining. We encourage physicians to really make sure the patient understands by asking them to repeat back what you’ve told them. Make sure they got the information.”
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