The British Medical Journal recently reported that the bulk of primary care* malpractice claims are due to missed diagnoses and drug errors—based on a study of missed diagnosis and drug errors published in the medical literature of the U.S., UK, Australia, France and Canada.
According to the BMJ Open article, “missed diagnoses were the most common source of malpractice claims, accounting for between a quarter (26%) and almost two thirds (63%) of the total.”
Misdiagnosis Blamed for Claims Before
The British Medical Journal isn’t the only one to notice. The Physician Insurers Association of America (PIAA) has the best closed physician claims database, and it is cumulative since 1985 with close to 270,000 total claims. According to the most recent PIAA report, the most prevalent medical misadventure in the three primary care specialties of pediatrics, internal medicine and general and family practice was diagnostic error.
- In pediatrics, this was the issue in 32.7% of claims
- In internal medicine, 26.7% of claims
- In general and family practice, 32% of all claims
This issue also received attention earlier this year in an AMA publication citing a previous BMJ article (chart, right).
What is troubling is that data from the National Practitioner Data Bank shows no decrease in the rate of diagnostic error resulting in claims from 1986 to 2010.
The Situation May Grow Worse
Here are some health care reform issues to chew on:
- More uninsured patients may enter the health care delivery system seeking primary care, due to the Affordable Care Act.
- Certain physicians may spend less time with patients with that increased volume
- This may drive up the number—even the rate—of misdiagnosis claims
- More physician extenders (PAs, NPs) will may be responsible for primary care, and they have less training than physicians. More claims?