Missed or delayed diagnoses most common in malpractice claims

MISSED or delayed diagnoses account for a significant percentage of malpractice claims in primary care according to a systematic review of studies conducted across five countries and published recently in BMJ Open.

Researchers in Dublin reviewed 34 studies of malpractice claims in primary care identified in a systematic literature search, including 15 based in the USA, nine in the UK, seven in Australia, one in Canada and two in France.

The researchers found that the commonest “medical misadventure” resulting in claims was failure or delay in diagnosis, accounting for 26–63 per cent of all claims across the included studies. These included missed or delayed diagnoses for cancer and myocardial infarction in adults and meningitis in children.

The second commonest domain was medication error, representing 5.6–20 per cent of claims across the included studies. Errors involving antibiotics, anticoagulants, antidepressants, antipsychotics and steroid preparations were most frequent.

The authors state that the prevalence of malpractice claims in primary care varied across countries.

"In the USA and Australia when compared with other clinical disciplines, general practice ranked in the top five specialties accounting for the most claims, representing 7.6–20 per cent of all claims. However, the majority of claims were successfully defended."

They conclude that the review highlights the need to prioritise the topics of diagnosis and medication error in developing educational strategies and risk management systems.

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