Malpractice Claims Alleging Diagnostic and Monitoring Omissions: Incidence, Severity, and Implications for Defensive Medicine. Executive Summary and Final Report

摘要

To provide an objective index of the pressures promoting defensive medicine, we analyzed malpractice claims derived from the database of a large insurer in a northeastern state. Claims filed between 1977 and 1989 were screened, reviewed by a physician, and classified as resulting from a diagnostic or monitoring omission or from some other cause. Omissions were numerically prominent in emergency medicine (14% of total claims) and internal medicine (13%) but rare in neurosurgery (2.1%). Compared to other claim types, omission-related claims were more likely to be paid, had a higher median payment, and were more often associated with significant patient injury or death. 'Little ticket' items (e.g. blood tests, plain x-rays) were more often the basis of omission-related claims than big ticket items (e.g. CT scans). We conclude that although omission related claims are relatively uncommon, they have substantial financial and psychological impact. Unless guidelines permitting physicians to practice with a reasonable amount of uncertainty are defended in court, defensive practices are likely to continue.