Malpractice risk at the physician level: Claim-prone physicians

Gómez‐Durán, Esperanza L.; Martín-Fumadó, Carles; Benet-Travé, Josep; Arimany–Manso, Josep

doi:10.1016/j.jflm.2018.06.004

Cited by 15 publications

(10 citation statements)

References 14 publications

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“…Overall, general surgery had higher risk of malpractice when compared with other surgical subspecialties, 18 54 however, agreement was not universal. 55 Grey literature and published academic papers reported GPs and family medicine specialists comprise a large proportion of total claims (34%–62%) and were up to three times as likely to be subject to claims.…”

Section: Resultsmentioning

confidence: 94%

“…Doctors who were a recipient of a previous claim were reported to be at 1.9 times greater risk of a repeated claim, 18 even when controlling for age, gender and specialty. 18 52 US doctors whose insurance providers required participation in educational courses were less likely to be sued. 63 Greater average doctor spending (eg, visits, tests, procedures) was associated with reduced risk of malpractice claim.…”

Section: Resultsmentioning

confidence: 96%

“…(One study investigating the predictive impact of age on claims reported age to have no effect. 18 The extent to which age is confounded with patient volumes is unclear and potentially important, as detailed examination has shown that the number of claims per 1000 patient encounters is higher for clinicians with lower numbers of patient encounters. 19 …”

Section: Resultsmentioning

confidence: 99%

“…reported age to have no effect. 18 The extent to which age is confounded with patient volumes is unclear and potentially important, as detailed examination has shown that the number of claims per 1000 patient encounters is higher for clinicians with lower numbers of patient encounters. 19 Impairment Younger doctors at risk of impaired performance were more likely to be affected by environmental factors (eg, work induced fatigue), 20 while older doctors (eg, 59-90 years of age) were at greater risk of impaired performance due to cognitive disorders.…”

Section: Spittal Et Al 2015 Australiamentioning

confidence: 99%

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Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

Austin

Nullwala

et al. 2021

BMJ Open

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ObjectiveTo identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners.DesignSystematic review.Data sourcesOvid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched.ResultsSixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out.ConclusionsIt is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor’s risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm.PROSPERO registration numberPROSPERO registration number: CRD42020182045.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Spittal Et Al 2015 Australiamentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

Austin

Nullwala

et al. 2021

BMJ Open

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“…The unequal distribution of medicolegal risk among practitioners has been described by others. [27][28][29] Based on the findings of this study, any O&G in private practice who on average has one or more requests for records, regulatory complaints or claims in any 2-year period should reflect on and address potential contributing factors that may include ways of communication, accessibility, technical standards of work and attitude to patient complaints, as well as environmental influencers. Contrary to some practitioners' beliefs, not only paid but also unpaid claims have predictive value in terms of future demands.…”

Section: Researchmentioning

confidence: 99%

A retrospective, observational study of medicolegal cases against obstetricians and gynaecologists in South Africa’s private sector

Taylor

Cleary

2021

S Afr Med J

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Background. The viability of obstetric practice in the private sector has been threatened as a result of steep increases in professional indemnity fees over the past 10 years. Despite this, empirical research investigating key aetiological factors to target risk management interventions has been lacking. Objectives. To explore private practice medicolegal data linked to obstetricians and gynaecologists (O&Gs) to identify factors in clinical practice associated with claims, for the purposes of guiding future research and risk management solutions. Methods. This was a retrospective, observational study of private sector O&Gs' medicolegal case histories. All incidents declared to a prominent local professional indemnity insurer were categorised in terms of medicolegal case type, as well as clinical parameters. To allow for risk-adjusted calculations of case incidence, year of entry into private practice was estimated for all practitioners. Results. Steep increases in medicolegal investigations and demands were demonstrated for both obstetrics-and gynaecology-related cases from about 2003 to 2012. Whereas the total numbers of claims, regulatory complaints and requests for records were similar for obstetrics and gynaecology in recent years (accounting for 52% v. 48% of known cases, respectively), a significantly greater percentage of demands and paid settlements related to gynaecology rather than obstetrics (58% and 76% v. 42% and 24% of cases, respectively). In obstetrics, about half of all cases on record with a paid settlement were in the context of severe neonatal birth-related neurological injury (n=9). For gynaecology, procedure-related complications accounted for 92% of settlements, of which at least 41% were for intraoperative injuries to internal organs and vessels. Laparoscopic procedures were most frequently associated with such intraoperative injuries, followed by vaginal and abdominal hysterectomies/oophorectomies and caesarean sections. For O&Gs in private practice for >2 years, 50/458 (11%) accounted for 138/228 (61%) of demands over a 10-year period. Conclusions. The higher number of gynaecological demands and settlements in comparison with obstetric cases was unexpected and is contrary to international experiences and public sector findings, calling for more research to identify reasons for this finding. Other than further exploring surgical outcomes in private sector gynaecological patients, aspects of surgical training and accreditation standards in gynaecology may need review. Regarding birth-related injuries, the contribution of system failures needs quantification and further interrogation. The high contribution towards the medicolegal burden by a small group of practitioners suggests a need for doctor-focused interventions, including strengthening of peer review and regulatory oversight.

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Claims in orthopedic foot/ankle surgery, how can they help to improve quality of care? A retrospective claim analysis

Sanders

Wimmer-Boelhouwers

Dijt

et al. 2020

Eur J Orthop Surg Traumatol

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Background Orthopedic foot/ankle surgery is a high risk specialty when it comes to malpractice claims. This study aims to evaluate the incidence, characteristics and outcome of claims in this area. Methods This was a retrospective, 10-year claim analysis, with data from an anonymous database. Baseline claim/claimant characteristics were collected from all orthopedic foot/ankle-related cases. Results Of 460 claims in total, most were related to delay in/wrong diagnosis or to (complications of) elective surgical procedures. Whether a claim was settled was related to type of injury (fracture) and type of claim (diagnostic mistake). Median amount disbursed in settled claims was €12,549. Claim incidence did not increase over the years. Conclusion Missed fracture diagnosis and “failed”/disappointing results of elective surgical procedures were the most common causes for claims. Sufficient knowledge of missed (foot) fractures and clear communication/expectation management before elective procedures could help to improve quality of healthcare and patient satisfaction.

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Malpractice risk at the physician level: Claim-prone physicians

Cited by 15 publications

References 14 publications

Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

A retrospective, observational study of medicolegal cases against obstetricians and gynaecologists in South Africa’s private sector

Claims in orthopedic foot/ankle surgery, how can they help to improve quality of care? A retrospective claim analysis

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