The Doctors Company recently completed an analysis of nearly 430 closed medical malpractice claims against cardiologists from 2007 to 2013. This data is relevant to cardiologists as well as general internists because both face similar liability threats. In a separate study of claims based on cardiac conditions, research showed that 22% of claims were against cardiologists, followed closely by internists at 19%. It’s important for both cardiologists and internists to gain a more sophisticated understanding of the malpractice landscape upon which they tread.
According to The Doctor’s Company report, the most common allegation was diagnostic error, which includes failure to establish a differential diagnosis or failure to order appropriate tests. This is clearly an issue that extends to both cardiologists and internists but in different ways. For internists, failure to diagnose a myocardial infarction is an important liability pitfall to consider. These problems are understandable given the diagnostic difficulties and potential harms associated with errors of this kind as well as the overall prevalence of heart disease.
For cardiologists, the closed claim data shows different potential risks. Failure to diagnose an acute coronary syndrome is less concerning than failure to diagnose “mimics,” such as aortic dissections presenting as chest pain, pulmonary embolisms presenting as shortness of breath, or cancer presenting as vague, non-specific symptoms. In the case of missed cancer diagnoses, failing to follow up on incidental masses found on imaging studies is a recurrent pitfall. Specialists sometimes develop tunnel vision, ignoring data and diagnoses outside their area of expertise.
Drugs & Procedural Injuries
Certain medications can be a source of liability danger because of their potential for side effects and/or their narrow therapeutic index. For example, some medications were noted to have multiple appearances in the closed claim data. Use of these drugs is acceptable, but it’s imperative that physicians have detailed discussions with patients about potential tradeoffs of using them and should document this discussion.
Procedural injuries are the second most common type of lawsuit revealed by the data. Cardiologists often perform high-risk procedures on critically ill patients, but lawsuits were often filed for procedural injuries that were a known complication and were discussed with patients during informed consent discussions. These complications can never be completely eliminated, even when physicians are clearly meeting standards of care. The key is for physicians to explain to patients that their complication was a recognized risk and was discussed prior to their procedure. With a better understanding of the data from The Doctor’s Company report, the hope is physicians become more aware of certain clinical scenarios to help them avoid lawsuits or minimize their impact.
Readings & Resources (click to view)
The Doctors Company. Cardiology closed claims study. Available at: www.thedoctors.com/cardiologystudy. Accessed February 25, 2015.
Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med. 2011;365:629-636.
Flannery FT, Parikh PD, Oetgen WJ. Characteristics of medical professional liability claims in patients treated by family medicine physicians. J Am Board Fam Med. 2010;23:753-761.
Oetgen WJ, Parikh PD, Cacchione JG, et al. Characteristics of medical professional liability claims in patients with cardiovascular diseases. Am J Cardiol. 2010;105:745-752.
Mangalmurti S, Seabury SA, Chandra A, Lakdawalla D, Oetgen WJ, Jena AB. Medical professional liability risk among US cardiologists. Am Heart J. 2014 May;167:690-696.
Seabury S, Chandra A, Lakdawalla D, Jena AB. Defense costs of medical malpractice claims. N Engl J Med. 2012;366:1354-1356.
Mangalmurti SS, Harold JG, Parikh PD, Flannery FT, Oetgen WJ. Characteristics of medical professional liability claims against internists. JAMA Intern Med. 2014;174:993-995.