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Diagnostic errors are largest contributor to medical malpractice claims

Errors related to diagnosis were the largest source of medical malpractice claims from 2013 to 2017, according to a new study, highlighting the challenges physicians face to make appropriate clinical decisions.

The report, published by malpractice services provider Coverys, found 33% of malpractice claims were related to errors made during patient diagnosis and more than half of those claims involved poor clinical decisions. Diagnosis-related claims beat out all other reasons for malpractice lawsuits. Surgical or procedural claims were the second most common reason at 24% while medical management claims came in third at 14%.

While many drivers of medical malpractice claims have seen decreases over the years, diagnosis-related claims have not, said Robert Hanscom, an author of the report and vice president of business analytics at Coverys.

"Nothing has moved the needle yet," he said. "We've got to start thinking innovatively."

The malpractice services provider reviewed 10,618 medical malpractice claims from 2013 to 2017. About 36% of the diagnosis-related claims involved the death of patient. Additionally, 36% occurred in outpatient settings. Hanscom said that correlates with the growing movement of care to outpatient from inpatient settings.

The analysis highlighted several times in the diagnostic process when physicians are vulnerable to making mistakes. About 33% of diagnosis-related suits occurred because the doctors failed to appropriately evaluate the patient, including getting an appropriate family history. Roughly 52% of claims involved errors related to lab testing. Doctors either chose the wrong test, improperly performed the test or misinterpreted the results.

Of all the claims studied, 14% were filed against radiologists. Oftentimes, radiologists create reports for doctors who analyze tests ordered. These reports can be long and complicated so it's easy for important information to get missed by the physician, Hanscom said.

Misdiagnoses usually occurs when physicians are bogged down by heavy workloads and siloed work environments that make a thorough diagnosis difficult, the report noted.

A team-based approach in which doctors are encouraged to discuss clinical cases with others is an effective tactic to improve diagnosis accuracy. "If there are several different people who are weighing in on the diagnosis, usually the right thing happens," Hanscom said.

A culture where doctors are told that it's OK to be unsure about a diagnosis and to seek help should be encouraged as well.

"There needs to be an environment where doctors can be more open about uncertainties around diagnosis. People expect doctors to know everything but sometimes they aren't certain," Hanscom added.

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Original URL: 
http://www.modernhealthcare.com/article/20180313/NEWS/180319965