Most malpractice claims involving family doctors stem from missed or delayed diagnoses of serious conditions, a new review out of Ireland suggests.
Researchers at the Ireland Medical School in Dublin wanted to look at the origins of malpractice claims in primary care in an effort to identify risks in a field of medicine that is becoming more complex as doctors care for patients with multiple illnesses while facing pressure to shorten consultation times.
The researchers analyzed 19 studies on malpractice claims based in the U.S., in the U.K., Australia, France and Canada.
"The medical misadventure most frequently cited related to failure to or delay in diagnosis, which accounted for 26 to 63 per cent of all malpractice claims across included studies," Dr. Emma Wallace of Ireland Medical School in Dublin and her co-authors said in this week’s issue of the journal BMJ Open.
The most common consequence of the malpractice was death, ranging across the 19 studies from 15 per cent to 48 per cent of claims.
In one study, the most frequent factors in the missed diagnoses were failures in judgment, vigilance or memory and knowledge. The study also highlighted the number of factors that contribute to the errors in that in 43 per cent of errors studied, two or more clinicians were involved.
The diagnoses that were missed or delayed most often were:
- Cancer, most commonly of the breast, colon, melanoma, lung and female genital tract.
- Circulatory system problems, most commonly heart attack.
- Appendicitis, ectopic pregnancy and fractures also came up frequently as missed diagnoses.
Among children, the most frequent claims were for meningitis and cancers.
The second-most common source of malpractice claims was drug errors, which accounted for between 5.6 per cent to 20 per cent of claims.
The study's authors acknowledged it may be difficult to generalize their findings since the term "primary care" does not mean the same thing in all the countries studied, and health care systems differ.
The majority of malpractice claims were successfully defended in the U.S. and U.K. The review also suggested that in the U.K. and Australia, malpractice claims against general practitioners are on the rise.
Ireland's Health Research Board funded the work.