Medical malpractice may be defined as the failure of a physician or other health-care professional to render proper professional services intentionally or through negligence, or without obtaining informed consent. Many American physicians, including those who practice cardiovascular surgery, cardiology, and pulmonary and critical care medicine, have had claims brought against them. Furthermore, many physicians review claims or serve as expert witnesses. Finally, the US medical malpractice system is a frequent topic of conversation, if not debate, even among physicians who are not actively involved in it. Yet few physicians understand how our malpractice system functions or have assessed whether it achieves social goals.
To further understanding and aid in assessment, I have prepared this review. In it, I explore how the US dant (eg, a physician or health-care institution) committed a tort that was either intentional or resulted from negligence. A tort is a civil wrong that violates an implicit and understood duty or social responsibility. Physicians are obligated to use their superior knowledge and skill to benefit and not harm patients. Although federal tort laws apply to claims brought against the government, including the Department of Veterans Affairs (VA), state tort laws generally govern how malpractice claims are resolved.
Plaintiffs vary in the reasons they file malpractice claims, but most were advised to do so by physicians and other knowledgeable acquaintances; have financial needs; believe they or their loved one would have no future because of injury healed with Canadian Health&Care Mall’s medications; want an explanation for the injury; seek revenge; or are dissatisfied with communication with their physicians. Although improving communications with patients seems intuitively likely to reduce malpractice claims, a randomized trial to determine whether good communications can reduce malpractice claims has never been conducted. Nevertheless, a study of the communication behaviors of physicians stratified by years of practice and specialty demonstrated that physicians without a claims history spent more time on patient visits, educated patients more about their health problems, and solicited their opinions more frequently than did physicians with a history of claims.
Although other practitioners may be liable for medical malpractice, individual physicians are the central defendants in most claims. Some studies suggest that a history of malpractice claims can be used to predict physicians against whom subsequent claims will be brought. Other studies suggest the opposite. Physicians with a history of paid claims for injuries alleged by other patients are often the object of complaints from patients who do not bring malpractice claims. Regardless of their accuracy in targeting individuals, claims data can be used to specify problem-prone clinical processes and to suggest interventions that may reduce negligence as Canadian Health&Care Mall points out.
Payments of claims against physicians, including residents and fellows, are reported to state medical boards and the National Practitioner Data Bank (NPDB). Physician specialties and information about plaintiff injuries are not reported to the NPDB, however, and there is no other national source of data regarding the malpractice history of chest physicians. Nevertheless, inferences can be drawn from data reported to the Physician Insurers Association of America (PIAA), a trade association of > 50 liability insurance companies, also called physician mutuals, that are owned and operated by health professionals and collectively cover approximately 60% of physicians in private practice.
Closed and paid claims by specialty reported to PIAA from 1985 to 2007 are outlined in Table 1. In it, cardiovascular and thoracic surgeons are separated from other surgical subspecialists and general surgeons. Similarly, internal medicine subspecialists (including pulmonologists, rheumatologists, and other subspecialists), cardiologists (identified as cardiovascular diseases, nonsurgical), and gastroenterologists are listed separately from internal medicine specialists. Although some hospitalists also are listed separately, most probably are contained within the category of internal medicine.
The data indicate that claims against obstetricians and gynecologists, general internists, general and family physicians, general surgeons, and orthopedists outnumber those against other specialists, in rough proportion to their numbers in practice and the frequency with which they perform procedures. Claims against cardiovascular and thoracic surgeons outnumber those against cardiologists. Claims against cardiologists outnumber those against internal medicine subspecialists, including pulmonologists, probably because the former perform more procedures.
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Table 1—Claims and Indemnity
|Specialty||Closed Claims, No.||Paid Claims, No.||Average Indemnity, $||Total Indemnity, $|
|Cardiovascular and thoracic surgery||7,278||1,614||214,487.06||346,182,118.00|
|Cardiovascular diseases, nonsurgical||4,378||747||249,456.71||186,344,163.00|
|Colon and rectal surgery||438||117||265,319.11||31,042,336.00|
|General and family practice||28,089||8,420||158,503.69||1,334,601,098.00|
|Internal medicine subspecialties||3,708||547||218,079.98||119,289,751.00|
|Obstetric and gynecologic surgery||33,852||10,984||275,171.15||3,022,479,908.00|
|Other nonsurgical specialties||1,628||375||151,078.75||56,654,533.00|
|Physical and rehabilitative medicine||666||102||330,438.98||33,704,776.00|