Wallace E, Lowry J, Smith SM, Fahey T, et al.
BMJ open. Date of publication 2013 Jul 18;volume 3(7):.
1. BMJ Open. 2013 Jul 18;3(7):e002929. doi: 10.1136/bmjopen-2013-002929. Print
2013.
The epidemiology of malpractice claims in primary care: a systematic review.
Wallace E(1), Lowry J, Smith SM, Fahey T.
Author information:
(1)HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland
Medical School, Dublin, Ireland.
OBJECTIVES: The aim of this systematic review was to examine the epidemiology of
malpractice claims in primary care.
DESIGN: A computerised systematic literature search was conducted. Studies were
included if they reported original data (≥10 cases) pertinent to malpractice
claims, were based in primary care and were published in the English language.
Data were synthesised using a narrative approach.
SETTING: Primary care.
PARTICIPANTS: Malpractice claimants.
PRIMARY OUTCOME: Malpractice claim (defined as a written demand for compensation
for medical injury). We recorded: medical misadventure cited in claims,
missed/delayed diagnoses cited in claims, outcome of claims, prevalence of
claims and compensation awarded to claimants.
RESULTS: Of the 7152 articles retrieved by electronic search, a total of 34
studies met the inclusion criteria and were included in the narrative analysis.
Twenty-eight studies presented data from medical indemnity malpractice claims
databases and six studies presented survey data. Fifteen studies were based in
the USA, nine in the UK, seven in Australia, one in Canada and two in France.
The commonest medical misadventure resulting in claims was failure to or delay
in diagnosis, which represented 26-63% of all claims across included studies.
Common missed or delayed diagnoses included cancer and myocardial infarction in
adults and meningitis in children. Medication error represented the second
commonest domain representing 5.6-20% of all claims across included studies. The
prevalence of malpractice claims in primary care varied across countries. In the
USA and Australia when compared with other clinical disciplines, general
practice ranked in the top five specialties accounting for the most claims,
representing 7.6-20% of all claims. However, the majority of claims were
successfully defended.
CONCLUSIONS: This review of malpractice claims in primary care highlights
diagnosis and medication error as areas to be prioritised in developing
educational strategies and risk management systems.
DOI: 10.1136/bmjopen-2013-002929
PMCID: PMC3693415
PMID: 23869100
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