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Medical Malpractice: A Physician’s Perspective

Medical Malpractice: A Physician’s Perspective. Kevin Biese, MD March 5 th , 2007. The Effect of CAPSTONE. 2 Requirements to be Good Intern. Try Hard Be Honest. Simple Phrase. “I Don’t Know” So Use Your Resources. Bad News. You Will get Sued 1 case per 10 physician years

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Medical Malpractice: A Physician’s Perspective

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  1. Medical Malpractice: A Physician’s Perspective Kevin Biese, MD March 5th, 2007

  2. The Effect of CAPSTONE

  3. 2 Requirements to be Good Intern • Try Hard • Be Honest

  4. Simple Phrase “I Don’t Know” So Use Your Resources

  5. Bad News • You Will get Sued • 1 case per 10 physician years • Some of you during residency • Over 20% of cases from academic centers involve residents • It happened to me • But I still have a job

  6. You Are a Doctor • Unfortunately, (usually) the law does not differentiate resident from attending • So you are responsible • However, you have lots of help • Attendings • Resident • Nurses • Books • UptoDate ……..

  7. Communication is Key

  8. Does the System Work: Medical Malpractice Goals • Deter bad care • Compensate the victims

  9. The Data: Harvard Medical Practice Study • Review of 31,429 random patient charts from 52 NY hospitals from 1984 • Looked for adverse events (injury caused by medical management) • First screen by NP for specific criteria (hospital trauma, drug reactions, readmission) • Next 2 physicians determined if adverse event • Finally physicians determined if negligence had caused the adverse event

  10. Harvard Medical Practice Study 31,429 in sample 7817 positive screen 1278 adverse events 306 with negligence

  11. Harvard Medical Practice Study • 3.7% hospitalized patients with adverse events • 1% hospitalized patients adverse events secondary to negligence • Extrapolation -In NY State in 1984 • 27,129 Injuries secondary to negligence • 6895 Deaths secondary to negligence

  12. Part II - Harvard Medical Practice Study • Examined types of errors and their association with negligence • Operative (53% of total / 17% negligent) • Drug-related (16% of total / 17% negligent) • Diagnostic (7% of total/ 75% negligent) • 70% of errors in ED associated with negligence (many diagnostic decisions)

  13. Part III - Harvard Medical Practice Study • Association of adverse events to malpractice claims • 47 cases from original 31,429 patients

  14. Part III - Harvard Medical Practice Study

  15. Part III - Harvard Medical Practice Study: Conclusions • Many more negligent injuries than claims • 98% of negligent injuries do not result in claim • Ratio negligence to claims = 7.6 to 1 • Poor correlation between negligent injuries and claims • Malpractice Goals • Deter bad care • Compensate victims

  16. Part IV - Harvard Medical Practice Study • 10 yr follow up of malpractice cases • No adverse events: 10/24 plaintiff • Adverse event, no negligence: 6/13 plaintiff • Adverse event, negligence: 5/9 plaintiff • Only independent predictor of payment was permanent disability • No association between adverse event (p=0.79) or negligence (p=0.32) and payment

  17. Conclusion • We are playing football on the freeway – we get pretty good at it, but you are gonna get hit • It is often not about you – we usually get sued for bad outcomes not bad practice • But, there are a lot of errors • And harm done …

  18. What to do • Communicate • Say when you do not know • Contact hospital legal as situations arise • Be kind

  19. What Not to Do • DO NOT • Pass judgment in the chart • You will become a plaintiff witness • Advise a patient to sue • Carelessly Email • Abandon your patient when something goes wrong • Modify the chart

  20. Final Thoughts • Most of us will get sued • We get sued for bad outcomes rather than bad practice • Be honest and willing to acknowledge what you do not know • Ask for help • Be Kind

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