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Top 10 Specialties Sued: 2013 Malpractice Report

Top 10 Specialties Sued: 2013 Malpractice Report

Nearly 1,400 physicians who were sued for medical malpractice share their experience in Medscape’s recent Malpractice Report. According to the report, the top 10 medical specialties experiencing the most lawsuits were: Most malpractice claims against primary care physicians are a result of missed diagnoses, particularly of cancer and myocardial infarction in adults and meningitis in children, as well as medication errors. Other highlights from the malpractice report include: 35% of lawsuits were “failure to diagnose” (17% “failure to treat”) 74% of physicians were surprised to be sued 24% of physicians sued were dismissed prior to deposition –  45% went to depositions –  21% went all the way to trial 61% took up to 2 years to conclude 57% of plaintiffs received no monetary award –  18% received up to $100,000 –  16% received up to $500,000 –  2% received over $2 million 62% of responding physicians said the lawsuit result was fair. In almost all cases, the insurer paid the full payout amount. 29% of physicians said they no longer trust patients and treat them differently. 93% of sued physicians said saying “I’m sorry” would not have helped. Respondents to the malpractice survey advise other doctors to: follow up even when you don’t think you have to; practice more defensive medicine; document more often and more thoroughly; and get rid of rude, demanding, noncompliant patients. Click here to view the full Malpractice Report by Medscape....

Most Docs Practice Defensive Medicine

You may have missed this when it first appeared. Experts from Harvard and the University of Southern California say assumptions made by some analysts that defensive medicine is not an important facet of the high cost of healthcare may be wrong. Those assumptions were based on data showing that malpractice reforms instituted in some states did little to reduce healthcare spending. According to the report from the National Center for Policy Analysis (NCPA) about an article in the Wall Street Journal, defensive medicine (“ordering some tests or consultations simply to avoid the appearance of malpractice”) is just as common in states with both low and high malpractice risk. In fact, about 2/3 of doctors in both the low- and high-risk states admitted to practicing defensive medicine. My experience is that the 2/3 figure is probably a very low estimate. Just about every physician I know has ordered a test or consult strictly to “cover his/her/their asses” if something were to go wrong. I am certain it happens tens of thousands of times per day in the US. I can cite many examples of defensive medicine: A young man with chest pain arrives in the ED. After taking a history and examining the patient, the ED MD is 99.95% certain that the patient did not have a heart attack or a pulmonary embolus. But he’s a little short of breath. He remembers a case of a fatal PE with only minimal shortness of breath, orders a blood gas and CT angiogram of the chest. A young girl comes in with lower abdominal pain, no GI symptoms, no fever. The pain...

Time Spent on Unresolved Malpractice Claims

The average physician in the United States spends nearly 11% of a 40-year career with an unresolved, open malpractice claim, according to a study from American researchers. The authors recommend that malpractice reform efforts be assessed based on the ability to reduce time of malpractice litigation without undermining the affected patient needs. Abstract: Health Affairs, January...

The “Second Victims” in Nursing

Tears rolled down my face as I came across an article written 2 years ago. A veteran pediatric nurse took her own life several months after administering a fatal overdose of an electrolyte to an infant. After investigations and undisclosed reasons, the hospital terminated the nurse’s employment after 27 years of service and dedication to the profession she truly loved. To further satisfy the state licensing disciplinary actions, she agreed to pay a fine and  undergo a 4-year probationary period. She would be supervised at any future nursing job when she gave medication. She even successfully completed a course to qualify as a flight nurse. Yet countless efforts did not produce any job offers, increasing her despair and isolation. A friend said, “She cried for weeks. Not just because she lost her job; she lost a child.” No one knows all the details that led to the nurse taking her own life. The reality is, the healthcare industry, I believe, is not set up to provide personal, psychological, and social  support to the “second victim” of medication errors. The first victims are the patients who were harmed and their families. Nurses are the providers of care and support for  patients. But who supports and advocates for nurses? Nursing, as noble as this profession may be, can also be a lion’s den. When mistakes happen, we are urged to “write it up,” appear in front of a committee, get judged, and God only knows what else. Then, labeled as “incompetent,”  an unseen force can immediately make the second victim even terrified to go back to work, adding to the feeling...

Unnecessary Pre-Op Tests & Evidence-Based Guidelines

Another paper on the subject of unnecessary preoperative laboratory testing appeared not long ago. A group from the University of Texas Medical Branch looked at more than 73,000 elective hernia repairs in the National Surgical Quality Improvement Project (NSQIP) database. Almost 2/3 of the patients had preoperative laboratory tests. Of that group, 58.6% had a CBC, 53.5% had electrolytes, 23.7% had liver function studies, 18.7% had coagulation studies, and 9.9% had all of the above. Even 54% of patients with no comorbidities had at least one test. [polldaddy poll=7007133] An abnormal test was found in more than 60% of those tested; of the 7,200 patients who had lab tests done on the day of surgery, 61.6% had at least one abnormal test, including 23% with a coagulation abnormality, 41% with a chemical abnormality, and 33% with a liver function test abnormality. Despite these results, the scheduled surgery was done. Tests did not predict complications in patients without comorbidities. Obtaining a test (not necessarily an abnormal result) was associated with a higher risk of major complications (0.4% versus 0.2% p < 0.0001) but not wound complications. However, abnormal results did not predict complications. The authors of the paper recommended that surgical societies establish guidelines for preop testing. Hernia patients, particularly those without comorbidities, are similar to normal people. Obtaining lab studies on these patients is analogous to obtaining labs on the next 100 people who walk past the hospital. Few abnormal results will be found, and most of them will be false positives. This fact has been known for at least 30 years, yet surgeons — who as shown by...
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