Posted by Bill Sandweg on 31 December 2018.
I am often asked what is the most common form of medical malpractice. Well, now we don’t need to rely on my opinion. We have an answer based on over 20 years of malpractice suits and payments.
In 1986, Congress established the National Practitioner Data Bank. It serves as a centralized database for all medical malpractice payments, whether by settlement or verdict, against individual doctors in the United States. It keeps records of the amount of the payment, the doctor for whom the payment was made, and the nature of the malpractice claimed by the patient. This information is not available to you or to me but it is available to those who study malpractice issues for research purposes. A recent article in a prestigious medical journal analyzed over 20 years of payments and discovered some interesting information. I will address some of the other noteworthy findings in a post next week.
While this image of a hemostat left inside a patient during surgery is pretty dramatic, surgical errors are not the most common form of medical malpractice, although they are a close second. The most common form of malpractice is the diagnostic error. Errors of diagnosis cover a lot of ground but generally mean that a physician reached the wrong conclusion about what is wrong with the patient.
The two medical specialties that had the highest rate of payments for diagnostic errors were pathology and radiology. I know that I have handled a number of cases in which a pathologist said a tissue sample was benign when it was, in fact, cancerous. I just finished a case in which the pathologist got it right and identified a cancer but no one bothered to tell the patient, who didn’t learn about the cancer diagnosis for almost two more years. Radiologists review hundreds of films a week. From time to time, they miss something. As with pathologists, the miss usually becomes an issue only when the thing they miss kills a patient or causes a significant injury short of death.
The second most common form of malpractice is the surgical error. Due to good operating room practices, cases of instruments left in patients have declined greatly. They still happen on occasion but are rare as the use of checklists has helped make sure that all instruments used in a surgery are accounted for at the end.
One of the most common surgical errors I see is cutting the wrong body part. A cardinal rule of surgery is that a surgeon must identify the body part before cutting it out. With the increase in laparoscopic surgery, in which the surgeon is operating while watching a video of the instruments inside the body, the ability to see is not the same as when the patient is “open” and instances of mis-identification are on the rise. I have had a number of cases in which the surgeon removing the gall bladder and the duct that connects it to the common bile duct coming from the liver cuts and removes the common bile duct by mistake. Oops! These cases of mistaken identity are rarely recognized at the time of surgery. Usually, it takes a few days and some unfortunate complications before the surgeon realizes the mistake.
Third place for most common malpractice goes to medication and treatment errors. I have written about the fact that medication errors are common in hospitals. Treatment errors involve everything from failing to be familiar with the patient’s medical records to making a mistake about what is the appropriate treatment for the patient.
There are lots of ways for doctors to make a mistake in your care. Be as vigilant as you can and you will reduce the chance that you will need to come see me.