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Diagnoses lead to medical professionals’ med mal claims

Medical professionals

The most common medical malpractice allegations against physician assistants and nurse practitioners are diagnosis-related, says a study issued Tuesday.

“While multiple factors — such as clinical judgement, technical skill, patient behaviors, communication, clinical systems, or documentation issues — may contribute to patient injury, the major contributing factor in our study involved history and physical examinations, and failure to address abnormal findings,” says the study issued by Napa, California-based medical malpractice insurer The Doctors Co.

The study is based on 649 claims that closed between 2012 and 2017, and was conducted by Dr. Howard Marcus, an Austin, Texas-based internist, and Susan Shephard, senior director of patient safety staff education at the insurer. About 60% of the claims were against physician assistants and the remaining 40% were against nurse practitioners.

About half of all physician assistant and nurse practitioner claims involved inadequate assessments that resulted in a failure or delay in diagnosis, said the study.

Issues included failure to establish a differential diagnosis, which involves the process of weighing the probability of one disease versus that of other diseases; failure to order diagnostic tests; inadequate history and physical examinations; and failure to address abnormal findings.

Another factor was communication among providers, said the study. In 22% of physician assistant claims and 25% of nurse practitioner claims, the providers did not communicate the patient’s condition or failed to read the medical record, the report said.

Risk mitigation strategies suggested in the report include following up on patient complaints and developing written guidance and protocols for these providers.

A new report issued Tuesday says self-insured hospital professional liability claims remain stable overall, but the frequency and severity of large excess claims continues to increase amid a rising number of large medical malpractice verdicts. 



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