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Missed diagnosis most common malpractice accusation made against primary care doctors

Accusations of diagnostic mistakes are by far the most common reason that Massachusetts primary care doctors get sued for malpractice, a new study found—alleged errors tied to failing to make an appropriate referral to a specialist, rushing through a physical exam, or neglecting to follow up on an abnormal test result.

A Brigham’s and Women’s Hospital study published Monday in JAMA Internal Medicine found that 72 percent of the time, malpractice suits against primary care physicians centered around misdiagnoses, and that suits against these doctors were more likely to be settled than those involving specialists such as obstetricians, surgeons, or oncologists.

“We’ve been hearing that diagnostic mistakes are a real problem in primary care practices,” said study leader Dr. Gordon D. Schiff, associate director of the Center for Safety Research and Practice at the Brigham. What was surprising, he added, was the “huge percentage” of lawsuits that stemmed from such mistakes.

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Schiff and his colleagues examined records from about 550 malpractice lawsuits involving Massachusetts primary care physicians from 2005 to 2009. They found that 190 included an accusation of a cancer misdiagnosis and an additional 108 claims alleged a doctor missed either heart disease, blood vessel diseases, infections, or strokes.

More than 35 percent of cases involving primary care doctors were settled by the malpractice insurers compared with 21 percent of those involving specialists. 1.6 percent of the lawsuits resulted in a verdict against the primary care doctor compared to 0.9 percent of the lawsuits against specialists.

“When someone finds an X-ray that hasn’t been followed up on or a referral that hasn’t been made, it’s less defensible in court than an unexpected surgery or obstetrics complication,” Schiff said.

With larger practices covering a broader array of health problems, primary care physicians often face added challenges when it comes to detecting and diagnosing health conditions. “Balls can get dropped if you don’t have very reliable systems” to establish these physicians as the gatekeepers who read test results that they ordered or refer their patients on if they don’t have the time or expertise to do the appropriate diagnostic workup, Schiff said.

While there’s clearly a need to improve, finding workable solutions could be tough. Schiff is gathering results from a federally-funded study he helped conduct called PROMISES—Proactive Reduction of Outpatient Malpractice-Improving Safety, Efficiency, and Satisfaction. It involves 25 primary care practices randomly selected to work with safety advisors to identify weak spots that could make them more vulnerable to malpractice. “We implemented some modest interventions, which may have led to some improvements but I fear that we won’t hit a home run,” he said. “There’s still a lot of potential vulnerability and a lot of potential for improvement.”

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