A new study on emergency room malpractice was released today that looks at why ER doctors are so frequently sued in misdiagnosis claims.
The study was conducted by The Doctors Company, which is a big insurer of doctors, hospitals, and physician groups. It is easy to roll your eyes because you know these folks come with an agenda. And of course, their conclusions are euphemistic distortions or maybe downright fictions, but I take most of the data at face value because I can’t see the point of cooking the relative malpractice incidence rates.
The study looked at 332 closed emergency room malpractice claims. Four types of cases made up the lion’s share of the cases:
- Misdiagnosis: 57%
- Improper Management: 13%
- Improper Treatment: 5%
- Failure to Order Medications: 3%
Misdiagnosis is the biggest culprit. The study says 57%; I would have put this number at 75 percent. Misdiagnosis includes failing to make a differential diagnosis and failing to consider all the symptoms of the patient’s condition. I would love to see data on “just didn’t know” versus “just didn’t take the time” because my very unscientific guess is that they are probably equally balanced. But the study takes a roundabout shot at trying to answer this question, breaking up misdiagnosis cases like this:
- Obese people are hard to treat because hospitals do not have the right equipment for them: 21%
- Communication errors which includes something that is surely not a communication error — failing to read the medical records: 17%
- Improper documentation: 13%
- Staffing problems: 12%
Okay, now we are getting a little crazy. Over 20% of the emergency department misdiagnosis cases are because they do not have the equipment to treat overweight patients? It is insane and the slant of the study comes out here. Blame everyone but the doctors regardless of whether it is a ridiculous reach.
Communication errors are a big one and often compounded by misdiagnosis. I settled a claim for millions, just last week, where there was a misdiagnosis and communication errors. The patient probably would have survived with one, but not both. That is how it often goes in these cases. Doctors certainly have less margin for error in their practice than I do as a lawyer. I’ll readily admit that. But often for things to have gone as badly for the malpractice to cause injury or death because there are systematic checks and balances that usually expand the margin for error.
Improper documentation could be a communication error. So the categorization is all goofy. Not reading the records, which is not a communication error, but improper documentation, which is a communication error, is not for this study. Got it? (Note: They may have had a good reason to categorize things as they did that I can’t figure out. I’m just mocking them, for it makes no sense to me. )
Anyway, the study concludes that emergency medicine doctors are “more prone to be sued for diagnosis-related issues than many other specialists because they treat patients unknown to them and who have a broad range of clinical problems.” Actually, that is not what the study says. But I can’t blame there for framing it that way.
The study hopes that this information will help doctors “focus on specific quality measures that will reduce exposure to malpractice claims and improve patient care.” I hope it does that. It certainly is interesting data.