Avoiding malpractice

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Coverys, a provider of medical professional liability insurance, recently released a report that examined five years’ worth of claims data that identify the biggest malpractice risks to primary care physicians. 

According to the report, diagnostic errors were the leading type of claim (46 percent) for primary care physicians, accounting for the highest proportion of indemnity paid (68 percent). 

Breakdowns in the diagnostic process of care most often included an incomplete capture of family history and the lack of a thorough physical exam (32 percent). The ordering of lab and diagnostic tests (30 percent) is the second most frequent allegation, and inadequate referrals (16 percent) are also a concern for providers. Cancer cases (50 percent) are the most frequent clinical condition associated with a diagnostic failure, with colorectal, lung and prostate cancers being the most common misses.

Medical Economics spoke with Coverys’ Robert Hanscom, vice president of business analytics, and Robin Webster, senior risk consultant, about the findings of the study and what physicians can do to reduce their malpractice risks.

Medical Economics: Were there any surprises in the key findings of the report?

Robin Webster: I can’t say I’m surprised by the data, because we’ve seen for a long time that diagnostic errors are out there.

Robert Hanscom: What was more of a surprise to me is that medication-related situations are still as pervasive as they are. They are not as high as they used to be, but the management of patients and their medication regimens are seeing some vulnerability to claims.

ME: What can primary care physicians learn from the study regarding how they should handle diagnosing patients?

Robin: From a risk-management perspective, ensure they are using established, written cancer-screening guidelines and getting patients in to physicals and referring them out for cancer screenings, if needed.

Robert: Get patients more engaged in the making of their diagnosis. Patient portals allow patients much better access to test results, which should be transparent. When patients have results with some uncertainty, tell them, “Here’s what we are going to do and what I think it might be.” Tell them what you are ruling out, what tests they need to take and make sure you are doing everything you can. By bringing the patient more into the diagnostic puzzle in front of providers, I think long term, it will help people get a more accurate diagnosis because they are more engaged and I think it will also reduce doctors’ risk.

Robin: Patient engagement is huge, especially when trying to close the referral loop. If the patient is engaged and you told them to expect a test result within a certain period of time and it doesn’t happen, they know to contact you to follow-up. The patient portal is becoming more important in playing a bigger role now to make sure information is communicated to the patient. In the past, doctors were expected to communicate by exception, like for abnormal test results. The expectation from the patient is only to hear about an abnormal result, and that no news is good news. We know now that strategy fails. It’s better to create a policy to communicate all test results to patients and create the expectation that patient will receive them.

ME: What should doctors do to minimize their malpractice risks related to communication issues with EHRs?

Robin: Actually look at how the system communicates between the primary care physician and a consulting doctor. Look to see how communication happens and if there is a documented handoff of the patient. In some cases, electronic records do a fantastic job with this. In others, physicians may not be fully utilizing its full communication ability. 

Robert: Identify the patients that got lost in the system and figure out what you can do to make the system work better and see if you can smooth out the issues. You can’t just stand by and let them fall through the cracks. Act immediately! If you are worrying at night about what happened to your patients in the system, that’s a real red flag.

ME: What other risk-recommendations does the data point to? 

Robin: Make sure patients are coming in for their annual physical exam. Close referral loops and make sure their EHR is tracking test results and engaging patients. For medications, make sure you have a process in place for informed consent. When you are talking to patients about opioids, you really need to have a thorough informed consent so they understand what the risks are. For care transitions, provide patients with written information when referring and scheduling follow-ups, especially when they are discharged from the hospital. Some physicians have done a good job identifying their high-risk patients, and that’s really important.

A copy of the report can be viewed here: http://view.ceros.com/coverys/red-signal-report-primary-care/p/1