Primary Care Malpractice claims against primary care physicians are more difficult to defend and lead to a higher percentage of paid claims. A recent study in the Journal of the American Medical Association (JAMA) reported a study of 7224 malpractice claims over a 5 year period in Massachusetts, with 551 arising from primary outpatient care. The study found that although primary care claims accounted for only 7.7% of claims, they were significantly more likely to be settled (35% vs. 20%) and/or result in a plaintiff's verdict (1.6% vs. 0.9%).
Most primary care malpractice claims are related to misdiagnosis or delayed diagnosis, which accounted for 85% of claims. The diagnosis of cancer, heart disease, vascular disease, infections and stroke were the leading conditions that were misdiagnosed or diagnosed after an unacceptable delay. Failure or delays in the diagnosis of breast cancer, lung cancer, colorectal cancer and prostate cancer are the leading causes of these claims. Other causes of claims are medication errors and other in-office medical treatments. Compared with claims against specialists, primary care claims are harder to defend. The increasing complexity of patients being treated as outpatients, discontinuities in care and increasing limitations on the amount of time that primary care doctors can spend with patients are the reasons. Even simple actions, such as following up on tests and making referrals, are creating malpractice exposure because of the increased volume of patients being seen.
When there is a failure to diagnose cancer or heart disease during early stages, the error often results in catastrophic injury when the diagnosis made only after the cancer has spread or the heart disease causes heart attack or stroke. Only a careful review of the primary care records can tell if such injury was preventable. As more care is transferred to the out-patient setting, the risk of errors by primary care physicians is also likely to increase.