“Although notable cases of wrong-site surgery or lethal medication errors may capture the newspaper headlines, most primary-care cases seem to be due to failures in more routine yet high-volume outpatient office processes,” researchers wrote. They added that most diagnosis failures were cancer-related and can often be traced to three general areas: Failures in physical examinations, evaluating symptoms, and obtaining and updating patient and patient-family medical histories; ordering or failure to order diagnostic or laboratory tests; and managing referrals and following up with the patient.
“It would appear that a finite number of safeguards could be put in place to prevent and/or mitigate these errors, which, in turn, could have a major effect on patient safety and malpractice,” the researchers concluded, adding that designing electronic health-record systems to help prevent these errors “represents a priority for preventing future malpractice.”
They added that outpatient primary-care diagnosis cases were more likely to result in a settlement or a victory for the plaintiff.
“This finding suggests that these cases may be harder to defend based on their malpractice insurers' review of the case or that a court ruled in favor of allegations of substandard care, which occurred in 36.8% of the primary-care diagnosis cases vs. 21.4% of all other non-general medicine cases,” researchers noted.
Lead author Dr. Gordon Schiff, with Harvard Medical School's Center for Patient Safety Research and Practice and an internist at Brigham and Women's Hospital, gave a preview of the report Wednesday at the sixth International Conference on Diagnostic Error in Medicine in Chicago.
It was lamented at the conference that diagnostic errors are not getting the attention they deserve. But Schiff cited a report from this year that found that more than 25% of cases filed in the National Practitioner Data Bank involving payouts between 1986 and 2010 were related to diagnostic errors.
“We didn't realize how much of a dominant problem these were,” Schiff said, adding that “a lot of this action is in the outpatient setting.”
The other leading causes contributing to malpractice claims in the Massachusetts study were medications, 68 (12.3%); medical treatment, 41 (7.4%) and communication, 15 (2.7%).
The two insurers that contributed the data are the Risk Management Foundation of the Harvard Medical School Institutions' Controlled Risk Insurance Co. and Coverys (formerly the ProMutual Group). Together they cover about 85% of the state's doctors.
While it was noted that the average time to close a case was three years, some of the cases studied were much older—including one that dated to 1989.
Follow Andis Robeznieks on Twitter: @MHARobeznieks