Six Top Malpractice Risks in Primary Care

Mark E. Crane


September 14, 2010

In This Article

Top Malpractices Risks

Colon cancer. These lawsuits often allege that appropriate screening tests that could have detected the disease in its early stages weren't performed. Failure to follow up on abnormal test results or failure to determine whether the patient actually went for a recommended colonoscopy are key issues. Primary care doctors have the responsibility of reminding, encouraging, and following up with patients to make sure they get their colonoscopy.

A typical charge in a malpractice suit is: "If only I had known why my doctor ordered the colonoscopy, I would have done it. He didn't explain how serious this was," says James Lewis Griffith Sr, an attorney in Philadelphia, Pennsylvania, who represents both plaintiffs and physicians. "Physicians need to communicate a sense of urgency and fully inform patients of the risks of failing to get tested. With patients they sense are reluctant, they can say, 'Let me call Dr. Smith right now while you're here and set up an appointment.' And of course, they must document this discussion in the patient's chart."

It's not uncommon for physicians to assume that patients, who may even have come to the office with information they printed from the Internet, are educated enough to understand the reasons and ramifications behind screening tests. However, that's not always the case.

Appendicitis. "Diagnosing appendicitis isn't as simple as the lay person thinks it might be," says Paul Gabel of NORCAL. "Several other conditions also have right-sided lower abdominal pain." Appendicitis symptoms can be subjective, and misdiagnosis rates for appendicitis are very high for children and particularly for infants. Because it progresses rapidly, it needs to be diagnosed quickly.

Lawsuits often allege inadequate examination and follow-up. Pitfalls include failing to document efforts to rule out appendicitis or spelling out follow-up plans if the patient's symptoms change or aren't resolved in a reasonable period, say risk managers.

Medication mistakes. Medication errors, particularly involving warfarin, result in thousands of hospital admissions each year. Close monitoring of anticoagulants is essential, and the treating physician must communicate to the patient potential interactions with foods and other medications. Following established monitoring policies and procedures is crucial.

The potential for medication mishaps has increased because of the growth of hospitalists. "The drug is started in the hospital, but is it clear to everyone who will do the follow-up?" asks Paul Gabel. "The handoff between hospital and office-based doctors is really critical. There should be a well-documented plan of action and strong communication between hospitalist and primary doctor. If there's a poor result, everyone will be sued, at least initially."


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