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Primary Care Malpractice Claims

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Primary Care Malpractice Claims are mostly a result of missed diagnoses and medication errors, a recent study in the British Medical Journal reports. Thirty four studies performed in the United States, United Kingdom, Australia, Canada and France were reviewed. The most common cause of malpractice claims were missed or delayed diagnosis, accounting from 26% to 63% of all claims in all the studies. Death was the most frequent result of these misdiagnoses. Failing to diagnose cancer, myocardial infarction and meningitis were the most common errors. Medication errors were the second most frequent cause for malpractice claims, totaling between 5.6% and 20% depending on the study reviewed. Errors occurred with multi-provider care, with 43% of errors involving 2 or more clinicians and 16% involving 3 or more clinicians.

In adults, the most frequent primary care malpractice claims were related to failing to diagnose cancers of the breast, colon, melanoma, lung and female genital tract and missing myocardial infarction led the list. Appendicitis, ectopic pregnancy and fractures were also commonly missed diagnoses. In children, the most frequent missed or delayed diagnoses concerned meningitis and cancer cases. Both individual errors (poor documentation, deficiencies in management and inadequate safety-netting) and system errors (poor communication between doctors in a practice and inadequate contingency planning for emergencies) were implicated in malpractice claims for children. Interestingly, many primary care claims do not result in compensation for the patients, with less than one third (31.9%) of primary care claims resulting in a payment in the United States, with an average payment in the United States of $253,739 and with a median payment of $199,389. These figures are consistent with other studies on payments reported to the National Practitioners Data Bank between 1986 and 2010.

While it is sometimes difficult to generalize across countries, this study showed that primary care physicians' failure to diagnose common conditions leads to serious consequences. The study also shows that, with awareness of these commonly missed diagnoses, primary care physicians should be better able recognize and diagnose. Physicians see what they look for and they look for what they know. Having knowledge of the increased risk of misdiagnosis for these common conditions is the first step to making the diagnosis. Looking specifically for signs and symptoms is the second step required to see what the underlying cause of the patient's problem is. Increased awareness and recognition of these common misdiagnoses should lead to better patient care, fewer errors and less injured patients.

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