Are Internists the Biggest Target for Lawsuits?

Wayne J. Guglielmo, MA

Disclosures

October 18, 2016

In This Article

Are Internists the Biggest Target for Lawsuits?

Internal medicine physicians are more likely to be sued for high-severity patient injuries than doctors in other specialties, according to a study released last month by The Doctors Company, the nation's largest physician-owned medical malpractice insurer.[1]

For the period of 2007-2014, researchers analyzed 1180 closed claims brought against internists, regardless of outcome. In addition to injury severity, they focused on five other areas of concern: most common patient allegations, most common patient injuries, factors contributing to patient injury, most common clinical conditions resulting in patient harm, and strategies for mitigating risk. The study incorporated case examples in order to better illustrate the points under review.

Diagnosis-related claims accounted for nearly 4 in 10 internal medicine claims (39%). In such cases, patients who sustained injuries alleged that their doctors either failed to diagnose their conditions correctly or failed to diagnose them in a timely manner. Diagnoses most often associated with these alleged lapses were myocardial infarction (6%), lung cancer (5%), colorectal cancer (5%), and prostate cancer (3%).

The two other most common patient allegations involved medical treatment (32%)—including a failure to order or delay in ordering diagnostic tests—and medication-related errors (19%). Together, the three top categories of complaints accounted for 90% of all patient allegations.

Claims against internists, researchers found, were more apt to involve high-severity injuries than those against other doctors. Dividing a scale employed by the National Association of Insurance Commissioners (NAIC) into low-, medium-, and high-severity categories—which ranged from "emotional only" to death—the study authors calculated that 58% of internal medicine claims involved a high-severity injury, while 34% of other doctor claims (excluding internal medicine) involved such injuries.

Researchers noted that this significant disparity in severity-related claims is due to "the important role internists have in the diagnostic process, as well as to the wide variety of conditions they treat."

What Factors Contribute to Patient Injury?

Experts identified faulty patient assessment (33%) as the leading factor in patient injury, which isn't surprising given the high percentage of diagnostic-related internal medicine claims. Incorrect diagnoses were often the result of some kind of failure—to establish a differential diagnosis, to order diagnostic tests, to address abnormal findings, or some combination of these. Diagnostic tests not ordered in a timely manner included blood panels, CT scans, x-rays, MRIs, colonoscopies, biopsies, ultrasounds, EKGs/echocardiograms, mammograms, and PET scans.

Internists can mitigate their risks, the study's authors say, by following a few common-sense steps:

  • Take time to explore patient complaints, especially when patients make similar complaints during return visits.

  • Evaluate all age groups of patients with atypical chest pain.

  • Pay close attention to calls and concerns from postoperative patients.

  • Ensure that there's a clear office policy and procedure for tracking diagnostic test results and conversations.

  • Confirm a patient's intention to comply with physician instructions and medication regimens.

According to the study, the majority of patient injuries—57%—occurred in the office or clinic setting, followed by hospitals (34%), skilled nursing facilities (5%), and other facilities (4%).

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