The Doctors Company, one of the largest medical professional liability insurance providers in the country, has recently released the results of a major study they’ve done analyzing malpractice claims brought against cardiologists. The authors of the study looked at 429 closed claims brought against cardiologists from 2007-2013 and analyzed both the types of claims brought against these doctors and the causes of the injuries alleged in the claims.
Types of Claims Made
Interestingly, one of the surveyors’ findings was that by far the most common type of claim brought against the cardiologists surveyed was to do with a diagnosis. Failure to diagnose, wrong diagnosis, and delayed diagnosis claims accounted for nearly twice as many allegations as improper management of care or improper treatment or performance of surgery. This is one of those areas that can be difficult to asses. On the one hand a statistic like this reminds us of why so many doctors engage in defensive medicine– to avoid a lawsuit for failure to diagnose or delayed diagnosis. But on the other hand, it is extremely important that doctors make sure they are establishing differential diagnosis, and taking stock of all the information at hand so as not to overlook or misdiagnose a serious condition through an overly narrow or incomplete diagnostic focus.
Here are the top five types of claims, accounting for 68% of all the claims surveyed.
- Diagnosis Related (failure, wrong, delayed) – 25%
- Improper Management of Treatment – 14%
- Improper Performance of Treatment or Procedure – 12%
- Improper Performance of Surgery – 11%
- Improper Medication Management – 6%
Causes of Injuries
Perhaps not surprisingly given what we noted about the frequency of diagnosis related claims, the top cause of injury according to TDC’s expert physician reviewers was found to be “patient assessment issues” at 25%. This stands to reason, but it also indicates that a fair number of those cases where patients brought diagnosis related claims against doctors were in fact cases where a diagnosis related issue did cause or contribute to injury. It seems that cardiologists have a greater chance of reducing their likelihood of facing a claim by focusing on improving assessment and diagnosis than just about any other change they could make.
The second largest cause of injury among the cases surveyed was “technical performance” at 21%. However, these are not necessarily instances of negligence on the part of the physicians. As the report notes, many of these instances reflect adverse effects, but not negligence. Cardiology and the procedures that go with it carry inherent risk, and in some cases injuries occur, but they were known risks identified to the patient prior to treatment. Just as an oncologist or radiologist is not guilty of malpractice if a patient suffers some of the known side effects of chemotherapy or radiation, so a cardiologist is not necessarily guilty of malpractice because a patient experiences an adverse effect of a risky procedure. The key here is communication. It is vital that doctors communicate clearly with patients, and get sufficient feedback to have confidence that patients understand the risks associated with treatments and procedures. But confidence is not enough; it is important to be able to demonstrate that this was done, so a paper trail showing that a patient was made aware of risks and possible outcomes is a vital part of mitigating risk.
Finally, another 20% of injuries reviewed were caused by “patient factors.” This is probably not a surprise to many doctors, but 20% of the injuries reviewed were caused by things like patients failing to take medications according to the proper schedule, patients failing to comply with therapy protocols, and patients otherwise not cooperating with treatment plans. Between this and what we discussed about “technical performance” and inherent risk we can see that right off the bat 41% of the injuries reviewed by TDC’s analysts were at least potentially not caused by negligence. Of course some of the “technical performance” related injuries surely were, but many were not.
Here are the top six causes of injury among the closed claims as reported by the study.
- Patient Assessment Issues – 25%
- Technical Performance – 21%
- Patient Factors – 20%
- Selection and Management of Therapy – 18%
- Communication Among Providers – 15%
- Communication between Patient/Family and Provider – 14%
Note how big a difference improved communication could make in reducing liability, both between healthcare professionals and between the provider and the patient. Between that and the importance of a renewed focus on careful and holistic assessment and diagnosis TDC has given cardiologists some very helpful insight on how they can best reduce their risk of being sued or causing harm.