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Defraia B, Focardi M, Grassi S, Chiavacci G, Faccioli S, Romano GF, Bianchi I, Pinchi V, Innocenti A. Negative Outcomes of Blepharoplasty and Thyroid Disorders: Is Compensation Always Due? A Case Report with a Literature Review. Diseases 2024; 12:75. [PMID: 38667533 PMCID: PMC11049061 DOI: 10.3390/diseases12040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Plastic surgery is one of the medical specialties with the highest risk of recurrent medical malpractice claims. The frequency of civil lawsuits represents an issue for the micro- and macro-economy of practitioners of these health treatments. This paper aims to discuss the medico-legal aspects and claim path in a case of a cosmetic blepharoplasty complicated by lagophthalmos wrongly related to the procedure but due to missed hyperthyroidism. CASE DESCRIPTION AND LITERATURE REVIEW A 48-year-old woman who underwent cosmetic blepharoplasty with undiagnosed hyperthyroidism claimed that the lagophthalmos that occurred some months after the procedure was due to medical malpractice, due to an over-resection of the exuberant lower eyelid tissue. The review question was, "Are thyroid disfunctions usually considered contraindications to be communicated to patients who undergo blepharoplasty?", and the databases MEDLINE via PubMed, Embase, Scopus, Ovid, ISI Web of Science, Cochrane, and Google Scholar were used. RESULTS AND DISCUSSION There were 21 eligible papers. The case highlights the importance and complexity of causal inference (such as unknown thyroid dysfunctions), related informed consent involving information on possible complications unrelated to malpractice, and guidelines recommending endocrinological consultation for cosmetic/functional blepharoplasty in patients at risk (e.g., female patients with a known history of thyroid disease).
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Affiliation(s)
- Beatrice Defraia
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Martina Focardi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Giulia Chiavacci
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
| | - Simone Faccioli
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
| | - Gianmaria Federico Romano
- Doctor in Medicine Specialized in Plastic Reconstruction and Aesthetic Surgery, Via Francesco Baracca, 1f, 50127 Firenze, Italy;
| | - Ilenia Bianchi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Vilma Pinchi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (B.D.); (M.F.); (S.G.); (G.C.); (S.F.); (V.P.)
- Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Alessandro Innocenti
- Plastic Reconstructive Microsurgery, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy;
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Lum ZC, Dennison S, Le HV, Bayne CO, Lee CA. Trends in Orthopaedic Surgery Workforce Diversity: Analyzing Changes Over Time. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00019. [PMID: 38648423 PMCID: PMC11037730 DOI: 10.5435/jaaosglobal-d-24-00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/11/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION There are many reasons why orthopaedic surgeons move or change careers. We asked the questions: (1) What is the geographic distribution of orthopaedic surgeons with respect to age, sex, and race and ethnicity? (2) How has our workforce changed over time with regard to these factors? (3) Are there any patterns or trends detected regarding policy or regulatory events that coincide with these differences? METHODS The American Academy of Orthopaedic Surgeons surveys over 30,000 members, collecting data on demographics, age, race sex, and practice statistics. We calculated geographic distributions and evaluated these differences over time-potential influences from malpractice suits or tort reform were investigated. RESULTS Overall surgeon density increased over time. The largest negative changes were noted in District of Columbia, Wyoming, and North Dakota and positive changes in Colorado, South Dakota, and West Virginia. Age across all states increased (mean 1.7 years). Number of female surgeons increased in most states (4.6% to 5.7%). Number of African Americans increased from 1.6% to 1.8%, Hispanic/LatinX from 1.8% to 2.2%, Asian from 5.5% to 6.7%, and multiracial from 0.8% to 1.2%. No change was noted in the percentage of Native American surgeons. DISCUSSION Surgeon density increased from 2012 to 2018; the cause for this change was not evident. Small increases in surgeon population, female surgeons, and in some underrepresented minorities were seen.
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Affiliation(s)
- Zachary C. Lum
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
| | - Stanley Dennison
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
| | - Hai V. Le
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
| | - Christopher O. Bayne
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
| | - Cassandra A. Lee
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
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Chao JC, Kheng M, Manzella A, Beninato T, Laird AM. Malpractice litigation after thyroid surgery: What factors favor surgeons? Surgery 2024; 175:90-98. [PMID: 37985316 DOI: 10.1016/j.surg.2023.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Litigation impacts physicians financially, reputationally, and professionally. Although thyroid surgery has favorable patient outcomes, litigation persists. We aimed to characterize malpractice claims after thyroidectomy and investigate which factors favor physicians. METHODS We queried the Westlaw legal database using the terms "thyroidectomy" and "medical malpractice" to identify malpractice cases brought against surgeons from 1949 to 2022. We collected and analyzed demographic; clinical; surgical; and legal data, including year, cause for initiating litigation, verdict, state where the lawsuit was brought, and the state's tort reform status. RESULTS Of the 68 cases included, medical negligence was the most common cause of action, followed by failure to provide adequate informed consent. The most common inciting surgical event was recurrent laryngeal nerve injury (n = 34, 50%). Surgeons prevailed more often overall (n = 53, 77.9%) and in 11 (91.7%) of the 12 cases treated at academic institutions. The 3 endocrine surgery fellowship-trained surgeons all prevailed in their cases. Of the 15 cases in which patients prevailed, 12 (80%) of which were decided by a jury, the median damages awarded were $569,668 (interquartile range $341,146-$2,594,050). In the 53 cases won by surgeons, 26 were jury decisions (49.1%). Surgeons prevailed in 87.5% of cases brought in the 24 states with tort reform and in 72.7% in the 44 states without tort reform. CONCLUSION Non-jury cases and operations done at academic institutions appear to favor decisions for the defendant. Although not statistically significant, all endocrine surgery fellowship-trained defendants won. Where tort reforms are in place, surgeons tend to prevail.
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Affiliation(s)
- Joshua C Chao
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
| | - Marin Kheng
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alexander Manzella
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Toni Beninato
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Amanda M Laird
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Adelani MA, Hong Z, Miller AN. Effect of Lawsuits on Professional Well-Being and Medical Error Rates Among Orthopaedic Surgeons. J Am Acad Orthop Surg 2023; Publish Ahead of Print:00124635-990000000-00721. [PMID: 37311452 DOI: 10.5435/jaaos-d-23-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/07/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Orthopaedic surgery is one of the most cited specialties among legal claims. Malpractice lawsuits are financially burdensome, increase defensive practices, and incur a notable emotional toll on defendants. We sought to determine the effect of malpractice lawsuits on professional well-being and self-reported medical errors among orthopaedic surgeons. METHODS We surveyed 305 members of the American Orthopaedic Association to collect information on experiences with medical malpractice lawsuits, demographic and practice characteristics, professional well-being on the Professional Fulfillment Index, and self-reported medical errors. Multivariable logistic regression identified predictors of malpractice lawsuits, professional well-being, and self-reported medical errors. RESULTS Seventy-three percent (224 of 305) respondents had been involved in a medical malpractice lawsuit. The odds of experiencing a malpractice lawsuit increased by seven percent with each year in practice (OR = 1.07, 95% CI: 1.04 to 1.10, P < 0.001) and with specialization in spine surgery. Respondents with a lawsuit in 2 years before the survey reported comparable professional well-being and medical error rates with those without a lawsuit. However, compared with respondents without a lawsuit, respondents with a lawsuit more than 2 years in the past were less likely to report burnout (OR = 0.43, 95% CI: 0.20 to 0.90, P = 0.03) and more likely to report a medical error in the past year, which resulted in patient harm (OR = 3.51, 95% CI: 1.39 to 8.91, P = 0.008). DISCUSSION While malpractice lawsuits negatively affect professional well-being, this effect resolves with time. The effect on medical errors may be more permanent; orthopaedic surgeons who have experienced a lawsuit reported greater rates of medical errors even after these legal issues have been settled. Among orthopaedic surgeons dealing with lawsuits, supportive interventions to protect professional well-being and mitigate the factors which lead to greater medical errors are needed. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- Muyibat A Adelani
- From the SSM Health Medical Group, St. Louis, MO (Adelani), and Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO (Hong and Miller)
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Hyman DA, Lerner J, Magid DJ, Black B. Association of Past and Future Paid Medical Malpractice Claims. JAMA HEALTH FORUM 2023; 4:e225436. [PMID: 36763369 PMCID: PMC9918873 DOI: 10.1001/jamahealthforum.2022.5436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Importance Many physicians believe that most medical malpractice claims are random events. This study assessed the association of prior paid claims (including a single prior claim) with future paid claims; whether public disclosure of prior paid claims affects future paid claims; and whether the association of prior and future paid claims decayed over time. Objective To examine the association of 1 or more prior paid medical malpractice claims with future paid claims. Design, Setting, and Participants This study assessed the association between prior paid claims (including a single prior claim) with future claims; whether public disclosure of prior claims affects future paid claims; and whether the association of prior and future paid claims decayed over time. This retrospective case-control study included all 881 876 licensed physicians in the US. All data analysis took place between July, 2018 and January, 2023. Exposure Paid medical malpractice claims. Main Outcome and Measures Association between a prior paid medical malpractice claim and likelihood of a paid claim in a future period, compared with simulated results expected if paid claims are random events. Using the same outcomes, we also assessed whether public disclosure of paid claims affects future paid claim rates. Results This study included all 881 876 physicians licensed to practice in the US at the time of the study. Overall, 3.3% of the 841 961 physicians with 0 paid claims in the prior period had 1 or more claims in the future period vs 12.4% of the 34 512 physicians with 1 paid claim in the prior period; 22.4% of the 4189 physicians with 2 paid claims in the prior period; and 37% of the 1214 physicians with 3 paid claims in the prior period. The association between prior claims and future claims was similar for high-medical-malpractice-risk and lower-risk specialties; 1 prior-period claim was associated with a 3.1 times higher likelihood of a future-period claim for high-risk specialties (95% CI, 2.8-3.4) vs a 4.2 times higher likelihood for lower-risk specialties (95% CI, 3.8-4.6). The predictive power of a prior paid claim for future claims declined gradually as the time since the prior claim increased, for prior or future periods up to 10 years. Public disclosure did not affect the association between prior and future paid claims. Conclusions and Relevance In this study of paid medical malpractice claims for all US physicians, a single prior paid claim was associated with substantial, long-lived higher future claim risk, independent of whether a physician was practicing in a high- or low-risk specialty, or whether a state publicly disclosed paid claims. Timely, noncoercive intervention, including education, has the potential to reduce future claims.
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Affiliation(s)
| | - Joshua Lerner
- NORC at the University of Chicago, Chicago, Illinois
| | - David J. Magid
- School of Public Health, University of Colorado, Lafayette
| | - Bernard Black
- Kellogg School of Management and Pritzker School of Law, Northwestern University, Chicago, Illinois
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Vetrugno G, Foti F, Grassi VM, De-Giorgio F, Cambieri A, Ghisellini R, Clemente F, Marchese L, Sabatelli G, Delogu G, Frati P, Fineschi V. Malpractice Claims and Incident Reporting: Two Faces of the Same Coin? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316253. [PMID: 36498327 PMCID: PMC9739332 DOI: 10.3390/ijerph192316253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 05/27/2023]
Abstract
Incident reporting is an important method to identify risks because learning from the reports is crucial in developing and implementing effective improvements. A medical malpractice claims analysis is an important tool in any case. Both incident reports and claims show cases of damage caused to patients, despite incident reporting comprising near misses, cases where no event occurred and no-harm events. We therefore compare the two worlds to assess whether they are similar or definitively different. From 1 January 2014 to 31 December 2021, the claims database of Policlinico Universitario A. Gemelli IRCCS collected 843 claims. From 1 January 2020 to 31 December 2021, the incident-reporting database collected 1919 events. In order to compare the two, we used IBNR calculation, usually adopted by the insurance industry to determine loss to a company and to evaluate the real number of adverse events that occurred. Indeed, the number of reported adverse events almost overlapped with the total number of events, which is indicative that incurred-but-not-reported events are practically irrelevant. The distribution of damage events reported as claims in the period from 1 January 2020 to 31 December 2021 and related to incidents that occurred in the months of the same period, grouped by quarter, was then compared with the distribution of damage events reported as adverse events and sentinel events in the same period, grouped by quarter. The analysis of the claims database showed that the claims trend is slightly decreasing. However, the analysis of the reports database showed that, in the period 2020-2021, the reports trend was increasing. In our study, the comparison of the two, malpractice claims and incident reporting, documented many differences and weak areas of overlap. Nevertheless, this contribution represents the first attempt to compare the two and new studies focusing on single types of adverse events are, therefore, desirable.
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Affiliation(s)
- Giuseppe Vetrugno
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Federica Foti
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Vincenzo M. Grassi
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Fabio De-Giorgio
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Andrea Cambieri
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
- Fondazione Policlinico A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | | | - Francesco Clemente
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Luca Marchese
- UOS Risk Management Fondazione Policlinico A. Gemelli IRCCS, Department of Health Surveillance and Bioethics, Section of Legal Medicine, School of Medicine, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Giuseppe Sabatelli
- Responsabile Centro Regionale Rischio Clinico Regione Lazio, 00145 Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
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Dong S, Shi C, Jia Z, Dong M, Xiao Y, Li G. The application of graph theoretical analysis to complex networks in medical malpractice: Lessons learned from China (Preprint). JMIR Med Inform 2021; 10:e35709. [DOI: 10.2196/35709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/28/2022] [Accepted: 09/24/2022] [Indexed: 11/13/2022] Open
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Austin EE, Do V, Nullwala R, Fajardo Pulido D, Hibbert PD, Braithwaite J, Arnolda G, Wiles LK, Theodorou T, Tran Y, Lystad RP, Hatem S, Long JC, Rapport F, Pantle A, Clay-Williams R. Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance. BMJ Open 2021; 11:e050377. [PMID: 34429317 PMCID: PMC8386219 DOI: 10.1136/bmjopen-2021-050377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners. DESIGN Systematic review. DATA SOURCES Ovid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched. RESULTS Sixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out. CONCLUSIONS It is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor's risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm. PROSPERO REGISTRATION NUMBER PROSPERO registration number: CRD42020182045.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Vu Do
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tahlia Theodorou
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Annette Pantle
- Medical Council of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Hsieh MT, Lu LH, Lin CW, Chen YW. Correlation Between Malpractice Litigation and Legislation Reform in Taiwan Over a 30-Year Period. Int J Gen Med 2021; 14:1889-1898. [PMID: 34040421 PMCID: PMC8139722 DOI: 10.2147/ijgm.s312640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background The annual medical litigation rate has increased yearly since 1987 in Taiwan. Policy makers keep going medical legislation reforms. The effectiveness of legislation reforms to reduce malpractice litigation risk is uncertain. Objective To determine whether medical legislation reform helps reduce the risk of medical litigation. Design, Setting, and Participants This retrospective study used national data obtained from Ministry of Health and Welfare in Taiwan. The period analyzed was from 1987 to 2018. The annual medical litigation rate was determined, types of medical negligence litigation were compared, medical appraisal results were summarized, and the importance of medical legislation was identified. Interventions After legislation reform vs before legislation reform. Measurements The main outcome showed trends in medical dispute assessments over time by adjusting for the general population (per 1, 000, 000 people). We established 2004 and 2012 as the 2 cut-points for further analysis of medical appraisal results due to legislation reform. Results With legislation reforms, the annual medical litigation rate decreased from 26.68 cases per million people in 2012 to 16.41 cases per million people in 2018. The annual medical litigation rate declined by approximately 38% from 2012 to 2018. Medical appraisal results were malpractice cases in 22.1% before Medical Care Act (2004 Reform) compared with 18.8% from 2004 to 2012 (odds ratio [OR], 0.82; 95% CI, 0.727–0.924; p=0.001), and 6.4% after mediation system introduced in 2012 (odds ratio [OR], 0.243; 95% CI, 0.205–0.288; p<0.001). Conclusion Medical legislation reform has reduced the risk of malpractice litigation over time.
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Affiliation(s)
- Ming-Ta Hsieh
- Department of Family Medicine and Community Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,College of Law, National University of Kaohsiung, Kaohsiung City, Taiwan.,Department of Nursing, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Li-Hui Lu
- College of Law, National University of Kaohsiung, Kaohsiung City, Taiwan
| | - Chi-Wei Lin
- Department of Family Medicine and Community Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Yun-Wen Chen
- Pediatrician, Local Clinic, Kaohsiung City, Taiwan
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Williams PL, Williams JP, Williams BR. The fine line of defensive medicine. J Forensic Leg Med 2021; 80:102170. [PMID: 33878590 DOI: 10.1016/j.jflm.2021.102170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
Defensive medicine is a practice that has been utilized by clinicians in efforts of preventing patient dissatisfaction and malpractice claims and may be done through either omission or commission. As much as 57% of physicians have disclosed that they practice defensive medicine. However, this practice does not necessarily prevent malpractice claims and more importantly, neither does it equate to good medical practice, with some leading to poor outcomes. Unfortunately, there is a high percentage of malpractice claims lodged against clinicians in both primary care and hospital settings. Specialists such as surgeons, obstetricians, and gynecologists face the highest claims. In particular, during the SARS CoV-2 pandemic, with new challenges and limited treatment algorithms, there is an even greater concern for possible bourgeoning claims. Counteracting defensive medicine can be accomplished through decriminalizing malpractice claims, leaving physician oversight up to state medical boards and hospital claims management committees. Additional tort reform measures must also be taken such as caps on noneconomic damages to ensure emphasis on beneficence and nonmaleficence. Once these are in place, it may well serve to increase clinician-patient trust and improve patient independence in the shared decision-making process of their treatment, allowing clinicians to practice their full scope of practice without feeling wary of potential malpractice claims.
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Affiliation(s)
- Preston L Williams
- University of Lynchburg, Doctor of Medical Science Program, 1501 Lakeside Drive, Lynchburg, VA, 24501, USA.
| | - Joanna P Williams
- Eisenhower Health, 39000 Bob Hope Drive, Rancho Mirage, CA, 92270, USA
| | - Bryce R Williams
- Palm Desert High School, 74910 Aztec Road, Palm Desert, CA, 92260, USA
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Mathew S, Samant N, Cooksey C, Ramm O. Knowledge, Attitudes, and Perceptions About Medicolegal Education: A Survey of OB/GYN Residents. Perm J 2021; 24:1-7. [PMID: 33482955 DOI: 10.7812/tpp/19.217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Medicolegal concerns affect the career decisions of obstetrics/gynecology (OB/GYN) residents; however, their exposure to medicolegal education during residency training is virtually unknown. OBJECTIVE To assess the knowledge, attitudes, and perceptions of medicolegal concepts among OB/GYN residents. METHODS All residents in an accredited residency training program in OB/GYN in the United States during the 2017-2018 academic year were invited to complete an anonymous online survey. RESULTS Of the 5152 OB/GYN residents invited to complete the survey; nearly 17% (n = 866) responded. Basic medicolegal knowledge was poor. Almost 60% of respondents (n = 500) could not identify malpractice as a form of tort liability. Among respondents, 44% (n = 378) reported receiving no medicolegal education during residency, 21% (n = 181) were unsure, and 34% (n = 293) reported receiving some education. Of those who reported receiving medicolegal education, the majority, 66% (n = 549), received it informally: by "word of mouth" or by "observing colleagues." Most (67%, n = 571) of the residents did not believe they had adequate exposure to medicolegal topics, and 19% (n = 163) were unsure. Ninety-two percent of residents (n = 782) reported concerns about being sued, and 67% (n = 571) believed that formal instruction during residency training may prevent lawsuits. CONCLUSION Exposure to medicolegal topics during OB/GYN residency training is very limited and unstructured. This study showed that residents desire a more formalized medicolegal curriculum during postgraduate training and that implementation may have several benefits.
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Affiliation(s)
- Shilpa Mathew
- Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA
| | | | | | - Olga Ramm
- Kaiser Permanente Oakland Medical Center, Oakland, CA
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12
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Medical malpractice and brachytherapy. Brachytherapy 2020; 20:950-955. [PMID: 32888853 DOI: 10.1016/j.brachy.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE On average, physicians spend 10 years embroiled in malpractice litigation, exacerbating burnout and depression. Only a limited number of studies regarding medical malpractice in radiation oncology have been published, mostly in the last few years. We undertook this review with the goal of looking specifically at brachytherapy-related medical malpractice literature. BASIC PROCEDURES We used the PubMed search engine using the terms radiation oncology medical malpractice. The search yielded 34 references published between 1988 and 2019. FINDINGS The incidence of radiation oncology malpractice claims was roughly similar to other specialties, with fairly typical payouts of $100,000-$200,000. Consistent with overall national medical malpractice statistics, a trend toward lesser numbers of radiation oncology claims from 1985 through 2017 has occurred. Medical malpractice data related specifically to brachytherapy are very, very limited. No author has provided sufficient details regarding precisely what leads to brachytherapy malpractice cases. CONCLUSION Hopefully, the recent spate of publications will segue into a more concerted effort to provide practitioners with detailed actionable descriptions of events leading to malpractice allegations.
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Derse AR. Medical Training and Errors: Competence, Culture, Caring, and Character. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1155-1158. [PMID: 31833851 DOI: 10.1097/acm.0000000000003118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Medical trainees will inevitably make errors as they learn. Errors should be minimized by a stronger focus on competence through better supervision and increased opportunities for simulation, as well as by reinforcing a culture that supports open identification of errors, disclosing errors to patients and families, and that focuses on prevention through quality improvement. Yet, errors are also opportunities for education and remediation. Medicine's duty of care includes care for those harmed through errors and should also include care for those who have made the error. Errors that cause harm to patients challenge trainees to engage the character traits of honesty, humility, trustworthiness, and compassion and to strengthen the practical wisdom to know when and how to exercise these character traits. The moral core of medicine-care of the patient in circumstances that may be uncertain and imperfect-as well as the duties of honesty, disclosure, repair, and redress may make equanimity (the calmness, composure, and evenness of temper needed in difficult and challenging situations) one of the most important character traits medical educators should identify, nurture, and encourage in trainees.
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Affiliation(s)
- Arthur R Derse
- A.R. Derse is Julia and David Uihlein Chair in Medical Humanities, professor of bioethics and emergency medicine, and director, Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin; ORCID: https://orcid.org/0000-0003-1896-1849
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Fields AC, Mello MM, Kachalia A. Apology laws and malpractice liability: what have we learned? BMJ Qual Saf 2020; 30:64-67. [PMID: 32561590 DOI: 10.1136/bmjqs-2020-010955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/10/2020] [Accepted: 05/31/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Adam C Fields
- Department of Quality and Safety, Brigham Health, Boston, Massachusetts, USA
| | - Michelle M Mello
- Stanford Law School, Stanford University, Stanford, California, USA.,Stanford Health Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Allen Kachalia
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Ho V, Tapaneeyakul S, Metcalfe L, Vu L, Short M. Using Medicare data to measure vertical integration of hospitals and physicians. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2020; 20:1-12. [PMID: 32099524 PMCID: PMC7036068 DOI: 10.1007/s10742-020-00207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/08/2020] [Accepted: 01/22/2020] [Indexed: 11/12/2022]
Abstract
Researchers, healthcare providers, and policy makers have become increasingly interested in the cost and quality effects of vertical integration (VI) between hospitals and physicians. However, tracking VI is often financially costly. Because the Medicare Data on Provider Practice and Specialty (MD-PPAS) annual dataset may be more cost-effective for researchers to access than private data sources, we examine the accuracy of MD-PPAS in identifying VI by comparing it to physician and hospital affiliations reported in Blue Cross Blue Shield Texas (BCBSTX) PPO claims data for 2014-2016. The BCBSTX data serve as a gold standard, because physician-hospital affiliations are based on the insurer's provider contract information. We merged the two datasets using the physician National Provider Identifier (NPI), then determined what percentage of physicians had the same Tax Identification Number (TIN) in both sources, and whether the TIN implied the physician belonged to a physician- or hospital-owned practice. We found that 71.3% of successfully matched NPIs reported the same TIN, and 95.1% of patient-level observations were attributed to organizations with the same ownership type in both datasets, regardless of TIN. We compared regression estimates of patient-level annual spending on an indicator variable for physician versus hospital ownership for the primary attributed physician and found that estimates were within one percentage point whether one determined VI based on the BCBSTX or the MD-PPAS data. The results suggest that MD-PPAS, which costs less to obtain than from a for-profit data source, can be used to reliably track VI between hospitals and physicians.
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Affiliation(s)
- Vivian Ho
- Baker Institute for Public Policy, Rice University, 6100 Main Street, MS 22, Houston, TX 77005 USA
- Department of Economics, Rice University, Houston, TX USA
- Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Sasathorn Tapaneeyakul
- Baker Institute for Public Policy, Rice University, 6100 Main Street, MS 22, Houston, TX 77005 USA
| | | | - Lan Vu
- Blue Cross Blue Shield of Texas, Richardson, TX USA
| | - Marah Short
- Baker Institute for Public Policy, Rice University, 6100 Main Street, MS 22, Houston, TX 77005 USA
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