Missed diagnoses and drug errors make up bulk of primary care malpractice claims

Missed or delayed diagnoses, particularly of cancer and myocardial infarction in adults and meningitis in children, were the most common cause of malpractice claims brought against doctors in primary care, a British meta-analysis of studies performed in different countries found, while medication errors were the second most common reason for claims.

Researchers included 34 studies of 10 or more malpractice claims and recorded the prevalence of, reasons for, outcomes of and compensation awarded for claims. Among the studies, 28 were from medical indemnity malpractice claims databases and the other six presented survey data. Fifteen studies were based in the U.S., nine were based in the U.K., seven were based in Australia, one was based in Canada and two were based in France.

Results appeared in the online journal BMJ Open on July 18.

Failure to diagnosis or delay of diagnosis was involved in 26% to 63% of all claims across the studies. Following cancer and heart attacks, the most common missed diagnoses were appendicitis, ectopic pregnancy and fractures. Medication errors represented the second most common reason for claims, with 5.6% to 20% of all claims across included studies. Death was the most commonly recorded patient outcome, ranging from 15% to 48% of outcomes noted in malpractice claims. In the U.S. and Australia, primary disciplines ranked in the top five specialties accounting for the most claims, representing 7.6% to 20% of all claims, when compared with other types of physician practices.

Researchers noted that in the U.K., general practitioners made up the greatest proportion of an overall 20% increase in claims between 2009 and 2010, with claims against them more than doubling between 1994 and 1999. In Australia, general practitioners comprised the highest proportion of claims and the highest number of new claims on the national Medical Indemnity National Collection database for both 2009 and 2010.

A substantial proportion of claims were unsuccessful, with only one-third of U.S. claims and half of U.K. claims resulting in a payment. But while the number of claims brought against U.S. doctors has remained fairly stable over the past two decades, those brought against Australian and U.K. GPs have been rising, the authors noted.

The researchers wrote, “The increasing recognition of primary care as a setting for adverse events places the development of fit-for-purpose educational strategies and risk management systems as a priority for those interested in promoting patient safety.”