Diagnostic errors are top reason for liability claims against primary care doctors, report says

primary care
To avoid diagnostic and treatment errors, primary care doctors should complete a physical exam on every patient, including a cancer screening, says a new report. (Getty/Milkos)

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 claims

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.

RELATED: Report identifies area for improvement in the diagnostic process to prevent medical errors 

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

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.