Factors impacting perceived threat of malpractice lawsuits by various medical specialists

Medical Liability in Obstetrics/Gynecology and Co-liability With Anesthesiology in Greece: A Retrospective Study

Objective To evaluate the current landscape regarding medical liability in obstetric-gynecology (OB/GYN) physicians in Greece. Materials and methods Published court decisions of criminal, civil, administrative, and disciplinary content were searched in legal information banks for the years 1988-2021. The causes that led to the adverse outcome and the decisions were analyzed. Results A total of 184 decisions were directed against OB/GYNs. One hundred seventeen records concerned criminal cases and 67 civil cases. Thirty-four decisions concerned criminal cases of negligent homicide, 35 criminal cases of bodily harm, and 19 were acquittals. The most common causes of bodily injuries were neonatal encephalopathy, obstetric paralysis - quadriplegia and brachial plexus paralysis, and obstetric bleeding. Conclusion According to our results, there is a great need and challenge to maintain high standards in daily practice with continuous training and the use of international protocols. Furthermore, for each case, continuous monitoring of parturients and newborns and coordinated cooperation are necessary to reduce mortality and morbidity.

A Long, Unnerving Road: Malpractice Claims Involving the Surgical Management of Thyroid and Parathyroid Disease

BACKGROUND

Given their profound emotional, physical, and financial toll on patients and surgeons, we studied the characteristics, costs, and contributing factors of thyroid and parathyroid surgical malpractice claims.

METHODS

Using the Controlled Risk Insurance Company Strategies' Comparative Benchmarking System database, representing ~30% of all US paid and unpaid malpractice claims, 5384 claims filed against general surgeons and otolaryngologists from 1995-2015 were reviewed to isolate claims involving the surgical management of thyroid and parathyroid disease. These claims were studied, and multivariable regression analysis was performed to identify factors associated with plaintiff payout.

RESULTS

One hundred twenty-eight thyroid and parathyroid surgical malpractice claims were isolated. The median time from alleged harm event to closure of a malpractice case was 39 months. The most common associated complications were bilateral recurrent laryngeal nerve (RLN) injury (n = 23) and hematoma (n = 18). Complications led to death in 18 cases. Patient payout occurred in 33% of claims (n = 42), and the median cost per claim was $277,913 (IQR $87,343-$783,663). On multivariable analysis, bilateral RLN injury was predictive of patient payout (OR 3.58, p = 0.03), while procedure, death, and surgeon specialty were not.

CONCLUSION

Though rare, malpractice claims related to thyroid and parathyroid surgery are costly, time-consuming, and reveal opportunities for early surgeon-patient resolution after poor outcomes.

Back to the future: five forgotten lessons for the healthcare managers of today

Nowadays, political, economic and technological upheavals require the rediscovery of some elapsed soft skills by healthcare managers. These abilities are values grounded in the past and somewhat nebulous in the present. We suggest five forgotten lessons highlighting the importance of a stronger human and self-conscious approach in today’s and tomorrow’s healthcare managers.

Medical malpractice in Iran: A systematic review

Background: Medical malpractice represents a serious problem in the health system and is one of the risk factors for patient safety which damages the patient and increases costs for the patient and the health care provider. The importance of these complaints against physicians is that litigation may continue for a long time and become problematic for patients and physicians. The objective of this study was to investigate the complaints of medical malpractices which were referred to Iran Medical Council to provide solutions to reduce the complaints and improve service delivery. Methods: Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, and Iranian databases, such as MagIran, SID, and Irandoc, were searched from 01/01/1990 to 07/01/2018. Also, the grey literature (via Google Scholar) was searched. Studies written in English or in Persian were searched, and keywords used included malpractice, negligence, medical malpractice, physician impairment, Iran, and professional impairment. Results: Nearly 1455 complaints (36%) of the total number of 3977 complaints were proved to be medical malpractice, and physicians were acquitted in 2542 (64%) cases. Most complaints were from gynaecologists, accounting for 43% of all complaints, followed by orthopaedic specialists who ranked second with 21.4% of the total complaints. The most type of failure was due to lack of skill (30.4%), followed by negligence (29.2%). Imprudence or indiscretion (26.3%) and noncompliance with governmental requirements (14.1%) were also in the next ranks, respectively. Conclusion: Improving patient and physician relationships, observing medical ethics, increasing the scientific and technical skills of the medical staff, and following the guidelines and medical protocols will prevent medical malpractice. Therefore, health policymakers can reduce errors and failures by adopting continuing education on medical, ethical, and legal issues.

Malpractice allegations: A reality check for resident physicians

BACKGROUND

Medical malpractice is a source of stress and cost to physicians. Little is known about how it impacts resident physicians.

METHODS

We analyzed data from the Comparative Benchmarking System between 2007 and 2016. We also surveyed surgery residents at our institution regarding malpractice in training.

RESULTS

4% of cases identified a resident physician and 32% involved a surgical specialty. Common allegations were "improper performance of surgery" and "improper management of surgical patient". 1 case attributed supervision as the major allegation but supervision was a contributing factor in 26% of cases. 18% of cases named a resident as a defendant. Most residents correctly answered that they can be defendants, agreed that a medico-legal curriculum is at least "moderately important", but had "poor" to "terrible" malpractice knowledge.

CONCLUSIONS

A significant number of medical malpractice claims involve resident physicians as a responsible party. Though universally recognized as important, medico-legal training in surgical residency is often lacking.

Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States

BACKGROUND

The US medical malpractice system assumes that the threat of liability should deter negligence, but it is unclear whether malpractice environment affects health care quality. We sought to explore the association between state malpractice environment and postoperative complication rates.

STUDY DESIGN

This observational study included Medicare fee-for-service beneficiaries undergoing one of the following operations in 2010: colorectal, lung, esophageal, or pancreatic resection, total knee arthroplasty, craniotomy, gastric bypass, abdominal aortic aneurysm repair, coronary artery bypass grafting, or cystectomy. The state-specific malpractice environment was measured by 2010 medical malpractice insurance premiums, state average award size, paid malpractice claims/100 physicians, and a composite malpractice measure. Outcomes of interest included 30-day readmission, mortality, and postoperative complications (eg sepsis, myocardial infarction [MI], pneumonia). Using Medicare administrative claims data, associations between malpractice environment and postoperative outcomes were estimated using hierarchical logistic regression models with hospital random-intercepts.

RESULTS

Measures of malpractice environment did not have significant, consistent associations with postoperative outcomes. No individual tort reform law was consistently associated with improved postoperative outcomes. Higher-risk state malpractice environment, based on the composite measure, was associated with higher likelihood of sepsis (odds ratio [OR] 1.22; 95% CI 1.07 to 1.39), MI (OR 1.14; 95% CI 1.06 to 1.23), pneumonia (OR 1.09; 95% CI 1.03 to 1.16), acute renal failure (OR 1.15; 95% CI 1.08 to 1.22), deep vein thrombosis/pulmonary embolism (OR 1.22; 95% CI 1.13 to 1.32), and gastrointestinal bleed (OR 1.18; 95% CI 1.08 to 1.30).

CONCLUSIONS

Higher risk malpractice environments were not consistently associated with a lower likelihood of surgical postoperative complications, bringing into question the ability of malpractice lawsuits to promote health care quality.

Patient and Practice Characteristics: Impact on Career Satisfaction of Obstetrician-Gynecologists

This study examined demographic and practice characteristics that affect the career satisfaction of obstetrician-gynecologists. Data were retrieved from the 2008 Health Tracking Physician Survey, conducted by the Center for Studying Health System Change. The survey consisted of a nationally representative sample of physicians belonging to the American Medical Association. A final sample of 290 obstetrician-gynecologists was obtained from the study. Results indicated more than 80% of obstetrician-gynecologists were either "somewhat satisfied" or "very satisfied" with their careers in medicine. Nearly 56% were older than 48 years; 59% of respondents were men and 77% were of white race. The average obstetrician-gynecologist worked 54 hours per week in medically related activities. Regression analysis showed a significant relationship between obstetrician-gynecologist career satisfaction and the following: adequate time with patients, perceived quality of care, income, work hours, and revenue from Medicaid. In addition, Hispanic patients and the presence of formal written guidelines had a positive impact on career satisfaction. It was concluded that quality care, time with patients, work hours, and income are the major predictors of obstetrician-gynecologist career satisfaction. Further research is needed to understand the relationship between patient demographics and career satisfaction.

Dimensions of quality care affecting career satisfaction of pediatricians

This study investigated factors impacting career satisfaction among pediatricians. The study used data from the 2008 Health Tracking Physician Survey, conducted by the Center for Studying Health System Change. The 2008 Health Tracking Physician Survey data set consisted of 4720 physicians who were members of the American Medical Association. Among the respondents, 427 identified themselves as pediatricians. Results indicated more than 52% of pediatricians were very satisfied with their careers in medicine. Nearly 35% of pediatricians were older than 48 years. Approximately 48% were male, and 67% were of white race. The average respondent worked 45 hours per week in medically related activities. Regression analysis indicated the following had a significant impact on pediatrician career satisfaction: inadequate time with patients, patient noncompliance, and delayed reports from other physicians and facilities. Number of hours worked per week and worry over potential malpractice suits also had a significant impact on career satisfaction of pediatricians.

Characteristics of paid malpractice claims settled in and out of court in the USA: a retrospective analysis

OBJECTIVE

An analysis of paid malpractice claims judged in court compared with those settled out of court may help explain perceptions of malpractice risk.

DESIGN

A retrospective analysis and cross-sectional comparison of malpractice claims. Evaluated trends in the number and proportion of paid claims, and mean payment amount by resolution type; identified patient, physician and claim characteristics associated with each resolution type. Examined the effects of resolution type on payment amount and time to claim resolution.

SETTING

Claims paid on behalf of US physicians reported in the National Practitioner Data Bank (NPDB) from 2005 to 2009.

MAIN OUTCOME MEASURES

Type of resolution, claim characteristics, payment amount and time to resolution.

RESULTS

Between 2005 and 2009, there were 58 667 claims paid on behalf of US physicians. Of these paid claims, 56 850 (96.9%) were settled outside court, and 1817 (3.1%) were judged in court. There was no significant change in the proportion of paid claims resolved by settlement versus judgement over time (p=0.83); nor was there a significant change in the mean payment amount in either resolution group (settlement, p=0.94; judgement, p=0.36). The claims in which the physicians were under 50, had prior malpractice reports, which were paid by a state malpractice programme, for adverse events to a fetus, and for surgical or obstetric error were more likely to be judged in court. The mean payment amount (US$592 283 vs US$317 447, p<0.01), per cent of payments over US$1 million (41.82% vs 15.43%, p<0.01), and time to decision (6.50 years vs 4.93 years, p<0.01) were significantly higher in judged claims.

CONCLUSIONS

Although only a very small percentage of paid malpractice claims in the USA are judged in court, a number of characteristics differ between settled and judged claims. Such differences may influence perceptions of malpractice risk and future reform efforts.

Screening colonoscopy in the US: attitudes and practices of primary care physicians

BACKGROUND

Rising colorectal cancer (CRC) screening rates in the last decade are attributable almost entirely to increased colonoscopy use. Little is known about factors driving the increase, but primary care physicians (PCPs) play a central role in CRC screening delivery.

OBJECTIVE

Explore PCP attitudes toward screening colonoscopy and their associations with CRC screening practice patterns.

DESIGN

Cross-sectional analysis of data from a nationally representative survey conducted in 2006-2007.

PARTICIPANTS

1,266 family physicians, general practitioners, general internists, and obstetrician-gynecologists.

MAIN MEASURES

Physician-reported changes in the volume of screening tests ordered, performed or supervised in the past 3 years, attitudes toward colonoscopy, the influence of evidence and perceived norms on their recommendations, challenges to screening, and practice characteristics.

RESULTS

The cooperation rate (excludes physicians without valid contact information) was 75%; 28% reported their volume of FOBT ordering had increased substantially or somewhat, and the majority (53%) reported their sigmoidoscopy volume decreased either substantially or somewhat. A majority (73%) reported that colonoscopy volume increased somewhat or substantially. The majority (86%) strongly agreed that colonoscopy was the best of the available CRC screening tests; 69% thought it was readily available for their patients; 59% strongly or somewhat agreed that they might be sued if they did not offer colonoscopy to their patients. All three attitudes were significantly related to substantial increases in colonoscopy ordering.

CONCLUSIONS

PCPs report greatly increased colonoscopy recommendation relative to other screening tests, and highly favorable attitudes about colonoscopy. Greater emphasis is needed on informed decision-making with patients about preferences for test options.