Interesting Read on Malpractice by Specialty (NEJM)

[cowme]

http://www.nejm.org/doi/full/10.1056/NEJMsa1012370#t=articleDiscussion

Some expected numbers here (ie. neurosurgeons with highest chance malpractice claims, psych with the lowest), but I'm a little surprised anesthesiologists, radiologists and Emergency physicians are right around the median in terms of malpractice claims.

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[Arcan57]

http://www.nejm.org/doi/full/10.1056/NEJMsa1012370#t=articleDiscussion

Some expected numbers here (ie. neurosurgeons with highest chance malpractice claims, psych with the lowest), but I'm a little surprised anesthesiologists, radiologists and Emergency physicians are right around the median in terms of malpractice claims.

Anesthesiologists have done a fantastic job of general anesthesia safe, and they are also quite good at risk-stratifying patients with a high likelihood of morbidity and mortality. Radiologists see a lot of studies but poor patient outcomes that are directly attributable to the radiologist are uncommon, especially considering the tendency to hedge on findings that carry high medicolegal risk. I have theories about EM's place on the list, mostly related to extensive training in minimizing medicolegal risk during residency but I'm not certain of the main cause. The high-dollar payouts I know about in EM have all involved egregious breaches in standard of care, things a PGY2 would shake their head at and say "What were they thinking?"

 

[jdh71]

Huh. I guess when peds cases go bad, they really, really, really go bad.

 

[DrBowtie]

Huh. I guess when peds cases go bad, they really, really, really go bad.

Jurys love disabled kids in the courtroom.

 

[jdh71]

Jurys love disabled kids in the courtroom.

Apparently. Peditricians are so low on the "who gets sued" table too. It's an interesting juxtaposition

 

[jdh71]

And when they say "pulmonary" they must mean critical care. I just can't see how anything pulmonary medicine does that has such a high risk of getting sued - bronch is the most invasive thing we do on the pulmonary side and that's not even that invasive. Steroids and inhalers? Must be the ICU they are counting.

I should just read the whole damn article.

 

[Rendar5]

And when they say "pulmonary" they must mean critical care. I just can't see how anything pulmonary medicine does that has such a high risk of getting sued - bronch is the most invasive thing we do on the pulmonary side and that's not even that invasive. Steroids and inhalers? Must be the ICU they are counting.

I should just read the whole damn article.

On a completely unrelated note, I get a kick out of your avatar everytime I see it, gunslinger.

 

[jdh71]

On a completely unrelated note, I get a kick out of your avatar everytime I see it, gunslinger.

Heh.

I used it when I modded a game of werewolf back in june, and a bunch of people talked me into keeping it instead of going back to the stop sign, saying I needed a new avatar for a new phase of life

 

[group_theory]

And when they say "pulmonary" they must mean critical care. I just can't see how anything pulmonary medicine does that has such a high risk of getting sued - bronch is the most invasive thing we do on the pulmonary side and that's not even that invasive. Steroids and inhalers? Must be the ICU they are counting.

I should just read the whole damn article.

Either ICU or "delayed diagnosis" of lung cancer since lung cancer is very prevalent. Not saying that it's the pulmonologist who is responsible for delayed diagnosis but when the diagnosis is made and there is a poor outcome (as usual with lung cancer), everyone who has ever seen the patient gets listed in the lawsuit for "delayed diagnosis". My guess is that is why there is a disconnect between being sued and payout for pulmonologist

 

[Law2Doc]

... I have theories about EM's place on the list, mostly related to extensive training in minimizing medicolegal risk during residency but I'm not certain of the main cause. The high-dollar payouts I know about in EM have all involved egregious breaches in standard of care, things a PGY2 would shake their head at and say "What were they thinking?"

EM physicians often do a good job of "loading the boat", and complicated patients generally have a Radiology study and a specialty consult in the chart to share/shoulder the blame if something gets missed. also the speed with which patients get processed and admitted or discharged has a lot to do with the liability -- if a patient is in the wards for three days there's a lot more time for malpractice to occur than the ED where he spent 3 hours.

 

[Rendar5]

EM physicians often do a good job of "loading the boat", and complicated patients generally have a Radiology study and a specialty consult in the chart to share/shoulder the blame if something gets missed. also the speed with which patients get processed and admitted or discharged has a lot to do with the liability -- if a patient is in the wards for three days there's a lot more time for malpractice to occur than the ED where he spent 3 hours.

ED docs make up in number of patients what they lack in time. You'd think more time with a patient would yield less mistakes, (but it is true, that it's also 3 days for you to make a crucial mistake)

 

[jdh71]

Either ICU or "delayed diagnosis" of lung cancer since lung cancer is very prevalent. Not saying that it's the pulmonologist who is responsible for delayed diagnosis but when the diagnosis is made and there is a poor outcome (as usual with lung cancer), everyone who has ever seen the patient gets listed in the lawsuit for "delayed diagnosis". My guess is that is why there is a disconnect between being sued and payout for pulmonologist

I can see that. Even then, still seems a bit high. But I suppose if those nodules, that were probably followed per routine for two years, eventually turn out to be cancer . . .