Diagnostic errors are the leading cause of liability claims against primary care doctors and account for the highest proportion of payouts, according to a new report.
Coverys, a Boston-based medical liability insurer, analyzed more than 1,800 closed medical professional liability claims brought against primary care doctors from 2013 to 2017.
Diagnostic errors accounted for 46% of the claims and accounted for the highest proportion of indemnity paid (68%), according to the report that examined where the major vulnerabilities lie for primary care doctors. And 45% of injuries in diagnosis-related cases resulted in a patient’s death.
Breakdowns happen in the diagnostic process in several places, the analysis found. One step ripe for error is pretty basic for primary care doctors: taking a complete family history and doing a thorough physical exam. The second most common problem alleged in malpractice claims? The ordering of lab and diagnostic tests. That was followed by inadequate referrals.
Cancer was the top clinical condition associated with a diagnostic failure (responsible for 50% of diagnostic-related claims), followed by infections (19%), cardiac/vascular (16%), and myocardial infarction-related injuries (11%). The top missed cancer diagnoses are colorectal (20%), lung (19%), prostate (11%), bladder (9%) and breast (8%).
Medical treatment claims
Treatment-related claims were the second most common claim made against primary care doctors (just over 20%), with the most allegations relating to the overall management of treatment (over 60% of the claims), followed by failure to treat and delay in treatment.
Medication-related claims are the third most common claim against primary care doctors. Physicians need to carefully monitor a patient’s medication regimen, the analysis found. These claims often result in high-severity injuries, especially when patients are taking high-risk medications such as anticoagulants and opioids. Those must be closely managed by physicians, as about 45% of medication-related claims and over 50% of indemnity payouts are directly related to allegations of inattentive monitoring and management.
Transitions in care claims
Another vulnerability for primary care doctors is when a patient is being transferred from one healthcare setting to another or being sent home. Those transitions in care resulted in just under 20% of claims. Patients are vulnerable to unexpected issues when the clinical care team fails to communicate and hand off critical information related to their care, the analysis found. The top problem was a delay or failure to obtain a specialty consult when clinically indicated (38%).
The report offers several ways that providers can avoid errors, including:
- Perform a complete age-appropriate history and physical exam on every patient, including a cancer screening.
- Close the referral loop, including using the electronic health record to track all ordered tests and consults.
- Prescribe and administer medications safely. This includes developing and implementing a process for obtaining informed consent when a patient is prescribed medications with a known degree of high risk.
- Ensure safe care transitions take place, including scheduling follow-up appointments for patients with complex medical needs within 14 days of discharge home after a hospital stay.