malpractice lawsuits more common in pathology

[scienceguy19]

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Among medical specialists, malpractice claims against pathologists were least frequently dismissed.

Suits against internists and internal medicine - 61.5% dismissed
Average across all specialties - 54.1% dismissed
Pathologists – 36.5% dismissed

http://www.darkdaily.com/medical-ma...sts-for-claims-and-lawsuits-822#axzz2EZCdhHOV

How sad! Wish we got more respect.

 

[NuckingFuts]

Among medical specialists, malpractice claims against pathologists were least frequently dismissed.

Suits against internists and internal medicine - 61.5% dismissed
Average across all specialties - 54.1% dismissed
Pathologists – 36.5% dismissed

http://www.darkdaily.com/medical-ma...sts-for-claims-and-lawsuits-822#axzz2EZCdhHOV

How sad! Wish we got more respect.

There's a term that I've heard being used in the clinical setting that struck me as being funny- when a clinician screws up, the event is called a "therapeutic misadventure."

"Diagnostic misadventures" are not allowed.

Regardless of the level of respect we may get- bottom line: we Pathologists are supposed to bat 1000.

 

[pathstudent]

There's a term that I've heard being used in the clinical setting that struck me as being funny- when a clinician screws up, the event is called a "therapeutic misadventure."

"Diagnostic misadventures" are not allowed.

Regardless of the level of respect we may get- bottom line: we Pathologists are supposed to bat 1000.

I know we are supposed to bat 1000 but I have often wondered if a misdiagnosis necessarily implies malpractice. Just because you were wrong doesn't mean you were negligent (i.e. maybe you stained it up and showed it to a colleague)or that the patient was not harmed by your misdiagnosis.

You need both right?

 

[scienceguy19]

With the bundled payments method (ACO) obamacare, I assume there will be more pressure to order fewer tests for cost savings. For pathologists, maybe this translates into ordering the minimum number of immunostains or not doing the molecular test. Problem is, we'd be working with less information. I guess that means we'll make more misdiagnoses and be sued even more??

 

[NuckingFuts]

I know we are supposed to bat 1000 but I have often wondered if a misdiagnosis necessarily implies malpractice. Just because you were wrong doesn't mean you were negligent (i.e. maybe you stained it up and showed it to a colleague)or that the patient was not harmed by your misdiagnosis.

You need both right?

I hear ya, but I suppose in a legal arena, one ought to wonder what (little) it takes to convince a jury of non-medical folk.

 

[Path or bust]

I know we are supposed to bat 1000 but I have often wondered if a misdiagnosis necessarily implies malpractice. Just because you were wrong doesn't mean you were negligent (i.e. maybe you stained it up and showed it to a colleague)or that the patient was not harmed by your misdiagnosis.

You need both right?

In order for malpractice to occur, you must prove harm. If the diagnosis was wrong, but the patient ended up being treated then you're ok. This is how a malpractice attorney explained it to us in med school. Many times though, this is not the case.

 

[deleted314957]

That's because when we screw up it is usually a real cluster f***. You call something cancer that is benign or you call something benign that is cancer. not as many shades of gray as "misadventures" in other specialties.

 

[NuckingFuts]

That's because when we screw up it is usually a real cluster f***. You call something cancer that is benign or you call something benign that is cancer. not as many shades of gray as "misadventures" in other specialties.

There is one example of a gray area that comes to mind- reactive atypia versus dysplasia/carcinoma in situ.

A group of influential attorneys constantly harassed my assistant for quite some time, trying to get in to my office to see me. When I finally met with them, they tried to get me to review cases where they were going after pathologists who had diagnosed "reactive atypia" on biopsy cases, which had then subsequently been diagnosed as "dysplasia" by some "expert" on second opinion. Their theory was, simply put, the diagnoses of "reactive atypia" had been erroneous, and therefore the initial pathologist deserved to be sued because their diagnosis led to a delay of diagnosis.

I tried to explain the concept of subjectivity to the sharks- all in vain. They knew of all the studies, and were well versed with the concept.

Long story short, I kindly asked the lawyers to get the fuq out of my office.

 

[gbwillner]

Among medical specialists, malpractice claims against pathologists were least frequently dismissed.

Suits against internists and internal medicine - 61.5% dismissed
Average across all specialties - 54.1% dismissed
Pathologists – 36.5% dismissed

http://www.darkdaily.com/medical-ma...sts-for-claims-and-lawsuits-822#axzz2EZCdhHOV

How sad! Wish we got more respect.

So what? I thought we were among the least likely to get sued in the first place...

Yup, here you go....

http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

 

[Substance]

I thought that paths were least likely to get sued but most likely to lose a suit?

Anyway, given that a lot of what you guys do is fraught with high inter-observer variability, does changing what you call "diagnoses" to "impressions" mitigate your risk since its a more accurate representation of what you're providing? Does giving a probability of reactive atypia vs dysplasia rather than a definitive 100% diagnoses also mitigate risk?

For example: saying something along the lines of:

Impression: Probably reactive atypia. Less likely dysplasia. This is based on x and y studies that show that the variability in diagnoses is x and y between observers. Clinical correlation is recommended.

Is this at all possible? To me it makes more sense.

 

[pathstudent]

I thought that paths were least likely to get sued but most likely to lose a suit?

Anyway, given that a lot of what you guys do is fraught with high inter-observer variability, does changing what you call "diagnoses" to "impressions" mitigate your risk since its a more accurate representation of what you're providing? Does giving a probability of reactive atypia vs dysplasia rather than a definitive 100% diagnoses also mitigate risk?

For example: saying something along the lines of:

Impression: Probably reactive atypia. Less likely dysplasia. This is based on x and y studies that show that the variability in diagnoses is x and y between observers. Clinical correlation is recommended.

Is this at all possible? To me it makes more sense.

Having served on the credentials committee (where you get to see any legal action brought against the doc when they first apply and every two years when they are renewed) for my hospital, I can say that for hospital based pathologists, we almost never get sued compared to other docs. No one in my group has ever been sued and some have been here for decades. Many of the docs get sued but it is types of cases where the lawyer sues every doc on the medical record but then most all of them get dropped once they figure out who is truly involved.

Again, I really feel like just because you misdiagnose something, doesn't make malpractice even if the patient was harmed. As it doesn't mean you were negligent. THat's why I am firm believer in showing a lot of cases to my colleagues. I figure if you were concerned enough about showing a case, that shows you weren't negligent.

 

[gbwillner]

From what I've seen/heard, a lot of lawsuits result from docs just being dishonest/trying to cover up their mistakes MORE than just making a mistake.

We will ALL make mistakes at some point. Admitting it, and correcting a report as soon as it is discovered is the BEST thing we can all do. We get into trouble when we blow it off and try to cover it up.

 

[Johnny Sunshine]

With the bundled payments method (ACO) obamacare, I assume there will be more pressure to order fewer tests for cost savings. For pathologists, maybe this translates into ordering the minimum number of immunostains or not doing the molecular test. Problem is, we'd be working with less information. I guess that means we'll make more misdiagnoses and be sued even more??

I suspect if we are pressured to order fewer immunos and such, there will be a tendency to include statistical information. Perhaps something along the lines of "Probable diagnosis of _____, based on positive IHC for XYZ, which is reactive in 85% of such entities", or something along those lines.

This is already done frequently on borderline or complicated cases.

 

[Substance]

From what I've seen/heard, a lot of lawsuits result from docs just being dishonest/trying to cover up their mistakes MORE than just making a mistake.

We will ALL make mistakes at some point. Admitting it, and correcting a report as soon as it is discovered is the BEST thing we can all do. We get into trouble when we blow it off and try to cover it up.

You're right about this. Doctors are given a lot of respect in courts of law, as much as many of you would like to think otherwise. Covering up error is a huge black mark on credibility. Even if one was not negligent/committing malpractice initially, or the case is borderline grey, they might be at fault if any uncouth behavior is unearthed.

 

[LADoc00]

Among medical specialists, malpractice claims against pathologists were least frequently dismissed.

Suits against internists and internal medicine - 61.5% dismissed
Average across all specialties - 54.1% dismissed
Pathologists – 36.5% dismissed

http://www.darkdaily.com/medical-ma...sts-for-claims-and-lawsuits-822#axzz2EZCdhHOV

How sad! Wish we got more respect.

You are very confused that is GOOD stat for us. What that is telling you is that when a Pathologist is sued he/she HAS made a mistake vs. other fields where they often sued by crazy patients with no basis in reality.

In terms of total malpractice risk, we are still near the bottom near Psych.

 

[yaah]

Yeah, when a pathologist gets sued it is usually because an error has been made, or perceived to be made. Otherwise the pathologist might never come to attention to the lawyer. So it isn't surprising at all that pathology suits have a higher percentage of settling.

 

[Kunu]

That's because when we screw up it is usually a real cluster f***. You call something cancer that is benign or you call something benign that is cancer. not as many shades of gray as "misadventures" in other specialties.

Mike, I know you're very experienced but I think this point is misleading. Im familliar with nearly as many issues with communication debates about how/ when/if a clinician was informed of a result, histo/labtech/clerical screw-ups, or gray-zone CP things when the clinical lab makes an error and its fuzzy on what degree of responsibility the Pathologist bears in some situations. I think its oversimplified to assume all path-suits are just wetting the bed at the scope on a bad day.

 

[Kunu]

From what I've seen/heard, a lot of lawsuits result from docs just being dishonest/trying to cover up their mistakes MORE than just making a mistake.

We will ALL make mistakes at some point. Admitting it, and correcting a report as soon as it is discovered is the BEST thing we can all do. We get into trouble when we blow it off and try to cover it up.

You are mistaken. Ive seen ridiculous egregious doctor inflicted damage go unpunished while other hopeless/helpless situations completely devoid of blame trigger suits/ settlements- supposed "birth injury" as a prime example. Certain fields such as OB have an inherent letigious climate and some patients/families are just out for blood *******s and will file suit over any negative outcome. They often are awarded settlement on the basis that admins will cut their losses whether there was legit breech of care or not.

 

[deleted314957]

You make a good point.

 

[gbwillner]

You are mistaken. Ive seen ridiculous egregious doctor inflicted damage go unpunished while other hopeless/helpless situations completely devoid of blame trigger suits/ settlements- supposed "birth injury" as a prime example. Certain fields such as OB have an inherent letigious climate and some patients/families are just out for blood *******s and will file suit over any negative outcome. They often are awarded settlement on the basis that admins will cut their losses whether there was legit breech of care or not.

I am speaking SPECIFICALLY about pathologists, although in truth all docs could stand to listen to this advice. When we do harm the cost/litigation can be significantly reduced simply by admitting error and awarding the patient for their harm before they get pissed off and get a lawyer. Most of the time, patients will NOT sue if 1) they still like their doctor and 2) think they are being treated fairly. Nothing gets them more pissed off and sue-y than feeling like they are being lied to.

Does that prevent ALL lawsuits? No, of course not. I'm sure we've all heard crazy stories of dumb lawsuits. But we've all seen dumb mistakes too. Catching them, and informing the patients in a timely manner, usually results in them being appreciative.

 

[NuckingFuts]

Catching them, and informing the patients in a timely manner, usually results in them being appreciative.

http://www.bostonglobe.com/lifestyle/health-wellness/2012/05/26/mass-hospitals-urged-apologize-settle/wY4Sf6N3Zka6JyXfnqSG1N/story.html

 

[gbwillner]

http://www.bostonglobe.com/lifestyle/health-wellness/2012/05/26/mass-hospitals-urged-apologize-settle/wY4Sf6N3Zka6JyXfnqSG1N/story.html

Good example.