Study shows best doctors may be sued the most
You know that doctor everyone thinks just isn’t quite up to speed and isn’t really the one you’d choose to take out your gallbladder? He’s not the one most likely to be sued for malpractice. It’s the doctor who would be your first choice when you go under the knife.
That’s the conclusion of a new study that may have been overlooked by risk managers because it was published in a journal devoted to family practice. The study suggests that the highest likelihood of being sued for medical malpractice lies with those physicians who are seen as the most knowledgeable and experienced.
Everyone involved with the research was surprised by the results, says lead author John Ely, MD, associate professor of family medicine at the University of Iowa in Iowa City. The research determined that risk factors for malpractice claims included graduation from a U.S. or Canadian medical school, specialty board certification, the American Medical Association’s Physician’s Recognition Award, and membership in the Alpha Omega Honor Society for physicians.1 Those are all good traits, so the research counters the common belief that the doctors who are sued the most are the doctors who deserve to be sued the most.
It doesn’t mean they’re bad physicians’
"Risk managers might want to reassure physicians that even if they’ve had some suits, it doesn’t mean they’re bad physicians," Ely tells Healthcare Risk Management. "You also could look at this data and say that being a great physician, in a technical sense, doesn’t protect you against malpractice."
Ely and his colleagues studied family physicians who practiced in Florida between 1971 and 1994. The results do not necessarily apply to all other medical specialties, but Ely says there is reason to believe the results would be substantially similar. The researchers collected data from the Florida Department of Insurance, which since 1974 has maintained a database of closed medical malpractice claims. The database was mandated by state law after malpractice claims skyrocketed in the mid-1970s. The state database includes records of more than 52,000 lawsuits against physicians.
The data show that for physicians with 10 or more years in practice, the risk of being sued at least once was 56% among those in a high-risk group, such as board-certified male physicians graduating from a U.S. medical school, whereas the risk was only 17% among physicians in a low-risk group, such as nonboard-certified female physicians from a medical school outside the United States. Physicians with three or more claims were most likely to have characteristics associated with greater knowledge. Also, physicians whose malpractice suits resulted in payment were more likely to be more knowledgeable.
There are several potential explanations for the findings. Ely refers to previous research showing that physicians with poor interpersonal skills are more likely to be sued and suggests there could be a connection. It is possible, he says, that physicians who have achieved great success and acquired great knowledge may tend to have poor interpersonal skills. "I don’t know why they would have the worst interpersonal skills, unless you think of the stereotypical student studying all the time, never going out to party," he says. "That student doesn’t develop interpersonal skills but develops great technical knowledge that will be recognized within the profession. Just a theory."
Another possible explanation is that the most knowledgeable physicians care for the sickest and most challenging patients, inevitably leading to some bad outcomes that could prompt lawsuits. Though the exact cause of the association between malpractice suits and medical knowledge may not be clear, Ely says the results clearly show a history of malpractice suits is not proof that the doctor’s skills or knowledge are inadequate. "I’ve gotten feedback from physicians who are glad to hear this. There was one letter from a physician in California who thanked me. He said he had been sued three times, but his board scores were always in the 90th percentile and he couldn’t figure out why he was getting sued."
Reference
1. Ely JW, Dawson JD, Young PR, et al. Malpractice claims against family physicians: Are the best doctors sued more? J Fam Pract 1999; 48:23-30.
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