Errors in diagnosis, improper procedures, and medication errors make up the top reasons that internists are sued, according to a study published online April 28 in JAMA Internal Medicine. A quarter of claims against internists result in payment, the study found.
Researchers studied 247,073 closed cases from 1985 to 2009 collected by PIAA (Physician Insurers Association of America), a trade association that represents domestic and international medical professional liability insurers. Of the closed claims, 14% were against internists. Twenty-six percent of the lawsuits against internists involved diagnostic errors, including allegations of misdiagnosing lung cancer, acute myocardial infarction, colon cancer, and breast cancer. Another 25% of claims involved no departure from the standard of care, while 11% related to improper performance of a procedure and 9% were attributed to medication errors, wrote Dr. Sandeep S. Mangalmurti, of Bassett Medical Center, Cooperstown, N.Y., and his colleagues (JAMA Intern. Med. 2014 April 28 [doi: 10.1001/jamainternmed.2014.1116]).
The results showed a wide variation among claims that resulted in payment against internists. For example, 40% of claims as a result of failure to refer and 38% of cases associated with failure to perform a procedure resulted in a claims payment. Cases in which no deviation from the standard of care occurred resulted in payment in 5% of suits. (In such cases, allegations such as failure to obtain consent or equipment were alleged.)
"Alleged departures from the appropriate standard of care are defined as medical misadventures," according to PIAA, the study, reported as a research letter, noted.
The findings confirm that internists are vulnerable to claims pertaining to their common practices of patient evaluation and health management, the authors noted. Insight into these claims patterns may help internists craft practice patterns and changes that will result in fewer patient injuries and fewer lawsuits, the authors said.