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Specialty where you're most likely to make a mistake?

doctorstrangerthingz

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    I was just wondering, in which specialties are doctors most likely to make errors?
    I know it depends on the individual doctor, and when it comes to surgical specialties it also depends on how skillful the surgeon is.

    I'm more interested in the specialties themselves. As in; a specialty where theres room for making medical errors or inaccurate diagnosis due to ambiguity within the field, complexity of the particular body system, nature of the practice, and so on.

    First thing that comes to mind is Internal medicine, emergency medicine, and psychiatry. I'm interested in hearing other people's thoughts. Would it be safe to say that doctors who specialize are less likely to make errors? (Since they narrow their focus on a specific body system and dive deep into it).
     

    siliso

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      B1356201-34F2-4DBE-A862-E8CCA4156FC9.jpeg I don’t think it quite breaks down that way. Everyone can and will make errors regardless of how expert or super specialized they are, because we work in complex/chaotic/unpredictable environment. If you want to know who is most likely to be sued for an error here’s a figure from NEJM 2011
      DOI: 10.1056/NEJMsa1012370
      But that doesn’t mean those surgeons made the most errors, it means they had the best evidentiary cases and potential payouts for malpractice attorneys working on contingency. We all make mistakes.
       

      MSTP18

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        I was just wondering, in which specialties are doctors most likely to make errors?
        I know it depends on the individual doctor, and when it comes to surgical specialties it also depends on how skillful the surgeon is.

        I'm more interested in the specialties themselves. As in; a specialty where theres room for making medical errors or inaccurate diagnosis due to ambiguity within the field, complexity of the particular body system, nature of the practice, and so on.

        First thing that comes to mind is Internal medicine, emergency medicine, and psychiatry. I'm interested in hearing other people's thoughts. Would it be safe to say that doctors who specialize are less likely to make errors? (Since they narrow their focus on a specific body system and dive deep into it).
        Your definition of error is a little weird. Based on the way you word it, I would say radiology, pathology, renal and rheum

        Definitely not true that that more specialized docs make fewer errors.

        View attachment 231206 I don’t think it quite breaks down that way. Everyone can and will make errors regardless of how expert or super specialized they are, because we work in complex/chaotic/unpredictable environment. If you want to know who is most likely to be sued for an error here’s a figure from NEJM 2011
        DOI: 10.1056/NEJMsa1012370
        But that doesn’t mean those surgeons made the most errors, it means they had the best evidentiary cases and potential payouts for malpractice attorneys working on contingency. We all make mistakes.
        For the orange bar, yes, but the blue bar is just any claim made and I'd say it's the specialties with the most likely "bad" outcomes (including failure to improve post procedure) combined with most obnoxious/unapologetic attendings
         
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        siliso

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          Yes the physician patient relationship is a big deal in terms of risk.

          I think the blue bar is at least somewhat meaningful again because malpractice attorneys generally work on contingency and will not accept/file a case that they don’t feel they stand a chance to get paid out on. Orange bar even more meaningful.
           

          libertyyne

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            View attachment 231206 I don’t think it quite breaks down that way. Everyone can and will make errors regardless of how expert or super specialized they are, because we work in complex/chaotic/unpredictable environment. If you want to know who is most likely to be sued for an error here’s a figure from NEJM 2011
            DOI: 10.1056/NEJMsa1012370
            But that doesn’t mean those surgeons made the most errors, it means they had the best evidentiary cases and potential payouts for malpractice attorneys working on contingency. We all make mistakes.
            IMO That chart represents outcomes where patients had loss of function or any other poor outcome, rather than anything else that happened during the care of those patients.
             

            libertyyne

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              OP people make errors in every speciality and I would go out on a limb and say those errors are probably made with frequencies that are a complex function of how many decisions the doctor has to make, how much communication needs to occur for the patients, how many orders / medications need to be entered into and EMR and administered.

              There is a difference between making errors and making errors which are immediately recognizable and caught vs making errors that do not impact the patient in a large negative way.
               

              Anti-PD1

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                View attachment 231206 I don’t think it quite breaks down that way. Everyone can and will make errors regardless of how expert or super specialized they are, because we work in complex/chaotic/unpredictable environment. If you want to know who is most likely to be sued for an error here’s a figure from NEJM 2011
                DOI: 10.1056/NEJMsa1012370
                But that doesn’t mean those surgeons made the most errors, it means they had the best evidentiary cases and potential payouts for malpractice attorneys working on contingency. We all make mistakes.

                Oh boy
                 
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                DrfluffyMD

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                  Your definition of error is a little weird. Based on the way you word it, I would say radiology, pathology, renal and rheum

                  Definitely not true that that more specialized docs make fewer errors.


                  For the orange bar, yes, but the blue bar is just any claim made and I'd say it's the specialties with the most likely "bad" outcomes (including failure to improve post procedure) combined with most obnoxious/unapologetic attendings

                  Just because a radiology read is “infectiou vs inflammation vs malignancy”, it doesn’t mean we are making errors. It means the finding is nonspecific on imaging.
                   
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                  siliso

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                    Last time I looked the most common claim against radiologists was missed finding on mammogram. The broad differential can be a hedge against a claim of missed finding, as can noting the limitations of a study (both of which can also be true and useful, not saying they are wrong to do or are only hedges against litigation).
                     

                    VA Hopeful Dr

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                      I would suspect that the greater chances for error are in fields with a broader range of knowledge and responsibility. This means us Primary Care folks and emergency medicine I think would be most prone to being wrong with a diagnosis.

                      Now thankfully in Primary Care my mistakes are less likely to lead to adverse outcomes compared to the folks on the upper end of the lawsuit Spectrum we saw previously posted.
                       

                      siliso

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                        OP you may be interested in Patient Safety - A Human Factors Approach by J Reason to understand more about systems-based analysis of medical error and mitigation thereof. Like I said the lawsuit question is interesting and may be (?) what you’re interested in but doesn’t really reflect the scope of diagnostic error or medical errors generally. Huge topic in healthcare.
                         
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                        siliso

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                          IMO That chart represents outcomes where patients had loss of function or any other poor outcome, rather than anything else that happened during the care of those patients.
                          Yes. Lawsuits require damages that can be causally linked to the care, and the bigger damages the better from a malpractice attorney perspective.
                           
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