Malpractice claims are a fear of every health care provider, for both the reputational and financial hit. A new piece of research in the journal Diagnosis evaluates the source of malpractice suits. (Diagnosis Study) The researchers looked at data from 2006 to 2015 from a large national malpractice insurer’s database, which includes over a quarter of all malpractice claims. They ranked the frequency and seriousness of various kinds of professional negligence claims, with death obviously being the most serious. There have been some pretty wild assertions about the prevalence of diagnostic error and the number of deaths and other harm resulting from those errors, so the authors were trying to find a more objective source of data. Out of over 55,000 closed claims, 11,600 were diagnostic in nature and about 7380 of these involved high-severity harm, including 53% that related to a death. Three diseases accounted for 74% of all these high-severity cases, with vascular issues representing 23%, infections 13.5% and cancer 38%. Clinical judgment lapses appeared to be the primary cause in most of these cases and communication issues were also frequently present. Most cases arose in an ambulatory setting, with the emergency room particularly prone to claims. 51% of cases involved a primary care physician. Somewhat surprisingly, infection cases had the highest median payouts, vascular issues had intermediate ones and cancer the lowest. The results from this study, if extended to the full set of claims, suggest that over this period there were over 12,000 deaths resulting from diagnostic errors, but the database only reflects closed claims so time attribution is uncertain, but it is likely that most serious cases of potential negligence are represented, since providers have every incentive to report such events to their insurers. While the estimates derived from this research are substantially lower than from some other sources, they still represent serious harm to a significant number of patients, harm which should be avoidable. And the fact that a few diseases account for so many serious claims indicates that further training and safety processes directed at those diseases could reduce malpractice significantly.
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The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at firstname.lastname@example.org.