July 21, 2013

162017_132140396847214_292624_nIn a study published on July 18, 2013 in the well-respected medical journal, BMJ (British Medical Journal), it was determined that misdiagnosis (failure to diagnose or delay in diagnosis) and medication errors, respectively, were the most common bases of medical malpractice claims (defined as a written demand for compensation for medical injury) in primary care. For medical malpractice claims involving adults, cancer and myocardial infarction were the most frequent diagnoses and for children, the most frequent diagnosis was meningitis.

The Study’s Methods

The study reported in BMJ involved a computerized literature search conducted in April 2012 and updated in January 2013 using PubMed, EMBASE, CINAHL, Cochrane library, Google scholar, Scirus, and legal databases (Heinonline, Justis, LexisNexis, and Westlaw). Studies were included only if they involved original data based on ten or more medical malpractice claims and involved primary care (defined as integrated, easy to access healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained and continuous relationship with patients, and practicing in the context of family and community).

Thirty-four studies met this study’s criteria from the 7,152 articles found as a result of the electronic search. Twenty-eight of those studies presented data from medical indemnity malpractice claims databases and six of the studies presented survey data. Of the thirty four studies, fifteen were based in the U.S., seven were based in Australia, one was based in Canada, and two were based in France.

Misdiagnosis And Delayed Diagnosis Claims

Medical malpractice claims based on misdiagnosis or delayed diagnosis accounted for 26% to 63% of all medical malpractice claims that were included in the study, with death being the most reported outcome (between 15% and 48% of the outcomes). The most frequent misdiagnosed or delayed cancer diagnoses in adults were for breast cancer, colon cancer, melanoma, lung cancer, and female genital tract cancers. The most frequent misdiagnosed or delayed non-cancer diagnoses in adults were for myocardial infarction followed by appendicitis, ectopic pregnancy, and fractures. The most frequent processes involved in the claims were the failure to order a diagnostic test, the failure to create a proper follow-up plan, the failure to adequately obtain a history or perform a physical examination, and the incorrect interpretation of a diagnostic test.

For children, the most frequent misdiagnosis or delayed diagnoses were for dehydration, meningitis, and congenital dislocation of the hip for children under 2; pneumonia, malignancy, and appendicitis for children from 3 to 11; and trauma, testicular torsion, pneumonia, malignancy, and appendicitis for children from 12 to 18.

Medication Errors Claims

Medical malpractice claims based on medication errors accounted for 5.6% to 20% of all medical malpractice claims that were included in the study. The most frequent medication errors involved prescribing errors, inappropriate medications, drug administration errors, dispensing errors, and adverse drug reactions. Medication errors included the following classes of medications: steroid preparations, antibiotics, anticoagulants, antidepressants, and antipsychotics. One of the studies found that 27% of medication errors were preventable.

Medical Malpractice Claims Outcomes

About one-third of medical malpractice claims involving primary care in the United States resulted in a payout to the claimant (it was about one-half in the United Kingdom). In the U.S., the mean payment for family practice malpractice claims was $253,739.69 and the median payment was $119,389.20.


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