Miriam E. Tucker

May 29, 2013

NATIONAL HARBOR, Maryland — The rate of medical malpractice claims is significantly lower for hospitalists than for other internal medicine physicians, a new study shows.

The retrospective observational analysis is the first to look at the rates, types, and causes of medical malpractice claims made against hospitalists in the United States.

Adam Schaffer, MD, presented the findings here at Hospital Medicine 2013.

"Perhaps the most notable finding we had was that the claims rate against hospitalists was significantly lower, almost 4-fold lower than against non-hospitalist internal medicine physicians," said Dr. Schaffer, from Harvard Medical School and Brigham and Women's Hospital, in Boston, Massachusetts.

One possible explanation is that a large proportion of claims against primary care physicians are related to cancer screening, particularly for breast cancer and colorectal cancer. Such claims would be much less likely to be made against hospitalists. "That possibly could be a factor in the mix, but our data don't provide a definitive answer to that question," Dr. Schaffer said.

 
I would have guessed that the inpatient setting would be higher-risk, but that was completely Gestalt.
 

Session comoderator Chad Whelan, MD, told Medscape Medical News that he was surprised by the findings. "I think many of us have believed for a long time that we're probably as likely or maybe more likely to be sued, but if this holds true, it looks like we're actually significantly less likely."

Dr. Whelan, from the University of Chicago, Illinois, added, "I would have guessed that the inpatient setting would be higher-risk, but that was completely Gestalt."

The data were obtained from a medical liability carrier-maintained database of more than 30,000 closed claims covering all medical specialties. It included academic medical centers, community hospitals, and private physician groups across the US.

The claims rate for the hospitalists was 0.52 per 100 physician-coverage years compared with 1.91 for nonhospitalist internists, a significant difference.

Researchers identified 272 claims from 1997 through 2011 for which a hospitalist physician was the attending of record. The mean age of the claimants was 56 years, and 51.8% were female.

Malpractice Claims Against Hospitalists n=272

Allegation Claims (%)
Treatment error 41.5
Missed or delayed diagnosis 36
Medication-related error 9.6
Inadequate monitoring 4.4
Errors in surgical treatment 3.3

 

By comparison, an analysis of 369 claims against general internists and subspecialists showed that the top 3 reasons are the same as for the hospitalists, but the order and the percentages differ: First is diagnosis-related (58%), followed by treatment errors (23%), and medication management (9.5%).

For the hospitalist claims, contributing factors included issues related to clinical judgment (54.4%), communication problems (36.4%), insufficient documentation (19.5%), and administrative problems (17.3%).

Payment was made on 32% of all hospitalist claims, similar to the 29.5% for nonhospitalist internists. The mean payment amount on the claims paid was $384,617, vs $451,713 for cases involving nonhospitalist internists. This difference was not statistically significant, Dr. Schaffer said.

Dr. Whelan told Medscape Medical News, "I would say this is in the very thought-provoking category. I think it raises a lot of questions. Probably some follow-up studies will answer some of those, but it's certainly got us all thinking differently than when we walked in the room."

Dr. Schaffer and Dr. Whelan have disclosed no relevant financial relationships.

Hospital Medicine 2013: Society of Hospital Medicine (SHM) Annual Meeting. Presented on May 18, 2013.

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