Book Review

Internal Medicine Malpractice Claims Study Reveals Most Common Claims

A new study of 1,180 closed malpractice claims* against internal medicine physicians shows that the most common claims are diagnosis related and that over half of these claims allege inadequate patient assessments. This analysis of allegations made by patients against internal medicine physicians—and the factors that led to these claims—was produced by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.

In the study, over a third of all claims alleged failed, delayed or wrong diagnosis (39 percent). The other top two allegations involved medical treatment (32 percent) and medication-related error (19 percent). The study further shows that internal medicine specialists have a significant percentage of high-severity patient injury claims compared with all other physician specialties. Severity of patient injury was higher—58 percent of claims against internal medicine physicians—compared to 34 percent of claims for all other physicians.

The study is based on claims that closed from 2007 through 2014. All claims were analyzed, regardless of their ultimate outcome. The research is unique compared with other studies of malpractice claims because it includes expert insights into the specific elements that led to the patient injury. Practicing physicians who reviewed the cases found that the top three factors that contributed to patient injury were patient assessment issues (33 percent), patient factors such as noncompliance to the treatment plan (25 percent) and communication breakdown between patient or family and the provider (21 percent). In the analysis, more than one factor often contributed to the injury.

The study also includes numerous examples of malpractice cases, the most common clinical conditions that resulted in patient harm, an analysis of the type of setting where most patient injuries occur, a comparison of frequency of claims against internal medicine physicians with those against hospitalists and a study of open claims, which helps to detect early changes in patterns of claim allegations.

“We hope that this information will assist risk managers in understanding common allegations and the factors behind these claims,” said study co-author David B. Troxel, MD, medical director, The Doctors Company. “With the data from this study and the details from the case studies, risk managers can work with physicians to identify system weaknesses, thereby reducing the risk of harm to patients.”

Copies of the full study are being provided to all attendees of the ASHRM 2016 Annual Conference in their welcome bags. Additional copies are also available at The Doctors Company’s booth 413 and at The Doctors Company also recently released a similar study on plastic surgery closed claims, available at and at The Doctors Company’s ASHRM booth.

*A written notice, demand, lawsuit, arbitration proceeding, or screening panel in which a demand is made for money or a bill reduction and which alleges injury, disability, sickness, disease, or death of a patient arising from the physician’s rendering or failing to render professional services.

Robin Diamond, MSN, JD, RN, is senior vice president of Patient Safety and Risk Management, The Doctors Company


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