Graham Center studies medical errors based on malpractice cases

BY J. MICHAEL BRODIE

WEB EXTRA!

A new study of malpractice claims takes a major step toward determining where errors by primary care physicians actually happen.

Researchers from the Robert Graham Center in Washington studied primary care malpractice claims settled between 1985 and 2000 in the United States and the United Kingdom, using the Physician Insurers Association of America malpractice claims database.

Of the nearly 50,000 claims against primary care physicians, the study focused on 5,921 claims that peer physicians determined involved medical negligence. Of that group, 68 percent involved negligent events in outpatient settings and resulted in more than 1,200 deaths.

So many claims from errors in outpatient settings surprised the researchers, said Robert Phillips, M.D., assistant director of the Graham Center and lead author of the study. Its results were published in the article "Learning From Malpractice Claims About Negligent, Adverse Events in Primary Care in the United States" in the April edition of Quality and Safety in Health Care.

More findings concerning the 5,921 claims:

2,751 claims involved general internists, 2,600 involved family physicians and general practitioners, and 570 involved pediatricians;
among the 10 most common medical conditions associated with negligent, adverse events, the most prominent (cited in 5 percent of cases) was acute myocardial infarction, followed by lung cancer, breast cancer and colon cancer (each cited in 3 percent of cases); and
the four leading causes for the claims were diagnostic error (in 34 percent of cases), failure to supervise or monitor the case (16 percent), improper performance (15 percent) and medication errors (8 percent).

"The category of diagnostic error doesn't give us enough information to fix the problems," explained Phillips. "For example, it doesn't tell us whether the wrong diagnosis resulted from a lab report that did not reach the physician or if a piece of information was placed in the wrong medical file or if the physician made an erroneous decision that could have been avoided with better training."

Phillips was quick to note that the study did not conclude that primary care physicians working in hospitals are any more prone to errors than other specialists. He did suggest that hospitals should make sure primary care physicians are included in efforts to improve inpatient care safety and the safety of patient transitions into and out of hospitals.

Phillips also suggested ways to improve malpractice data -- more peer review of cases and more collection of contributing factors -- changes that could bolster the effort to improve patient safety. In addition, he made a case for implementing electronic health records.

"The hundreds of people harmed, maimed or killed by errors for which 'problems with records' or 'communication between providers' contributed might have survived unscathed if an EHR was used," he said.

The study is just the start of a conversation about helping physicians avoid tragic outcomes. "We want to help physicians understand that if they have concerns that a patient may be exhibiting symptoms of these particular error- or suit-prone diseases, they need to be extra cautious," said Phillips. "We should also work with malpractice companies to collect data about system factors that contribute to error-related suits so that we can design more effective and safe systems."

To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.

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