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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 l.jpg

Medical Malpractice: A Physician’s Perspective

Kevin Biese, MD

March 5th, 2007




Simple phrase l.jpg
Simple Phrase

“I Don’t Know”

So

Use Your Resources


Bad news l.jpg
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


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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 ……..



Does the system work medical malpractice goals l.jpg
Does the System Work: Medical Malpractice Goals

  • Deter bad care

  • Compensate the victims


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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


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Harvard Medical Practice Study

31,429 in

sample

7817 positive

screen

1278 adverse

events

306 with

negligence


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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


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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)


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Part III - Harvard Medical Practice Study

  • Association of adverse events to malpractice claims

  • 47 cases from

    original 31,429 patients



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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


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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


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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 …


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What to do

  • Communicate

  • Say when you do not know

  • Contact hospital legal as situations arise

  • Be kind


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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


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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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