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When Primary Care Physicians Miss Diagnoses: the Main Reasons for PCP Malpractice Claims

Doctor and Patient
Prostate cancer is treatable and does not, in fact, prove fatal to most of the men who are diagnosed with it. National Cancer Institute

Primary care physicians have historically been less likely to be targeted for malpractice lawsuits, but a recent report emphasizes that they certainly aren't exempt from it.

The analysis report in the online journal BMJ Open found that missed diagnoses, especially of cancer, heart attack, and meningitis, make up the majority of malpractice claims in primary care. The second most common cause for malpractice claims was drug errors, and the most characteristic consequence of these missed diagnoses or errors was patient death.

Primary care physicians were also likely to be sued for missed diagnoses regarding appendicitis, ectopic pregnancy, and fractures, as well as meningitis and cancers for children.

"We have every reason to believe that diagnostic errors are a major, major public health problem," Dr. David Newman-Toker of Johns Hopkins University School of Medicine, told Reuters Health. "You're really talking about at least 150,000 people per year, deaths or disabilities that are resulting from this problem." 

To become a primary care physicians (PCPs), otherwise known as general practitioners (GPs), medical school graduates train in primary care programs such as family medicine, pediatrics or internal medicine. Physicians who specialize in internal medicine, often called internists, focus on taking care of patients who have multi-system disease processes.  The phrase internal medicine is from the German Innere Medizin, which was used to describe physicians who integrated science with patient care in Germany.

The PCP will typically be the first medical contact for a patient, due to easy communication, an accessible location, familiarity, and the likelihood that the PCP is often the patient's "family doctor." Sometimes PCPs are considered the "gatekeepers" who will refer patients to a specialist after completing the initial tests. The PCP will also sometimes remain the point of continuing care for the patient, especially for long-term management of chronic conditions that involve different organ systems.

In the U.S., about 7.6 percent to 16 percent of total malpractice claims are those brought against primary care doctors, according to the report. Interestingly, in Australia, PCPs (called general practitioners, or GPs, there) accounted for the highest proportion of malpractice claims on the national Medical Indemnity National Collection database for 2009 and 2010. And in the UK, the amount of claims against PCPs doubled from 1994 to 1999. However, the authors of the report noted that since healthcare was different in each country, and "primary care" is not the same in all countries, their findings could not be generalized.

A 2002 report said that the low rates of malpractice claims against primary care physicians could be attributed to several factors: "the esteem held by internal medicine and family medicine physicians in their communities, relatively low numbers of invasive procedures, reluctance of patients to include 'their' primary care physician in any potential litigation, and, probably most importantly, the atmosphere of mutual trust and communication between the internist or family physician and the patient."

In 2011, the New England Journal of Medicine published a report stating that 75 percent of physicians in "low risk" specialties, and 100 percent of physicians in "high risk" specialties, should expect to face a malpractice claim during their career - but that a majority of malpractice claims did not actually lead to indemnity payments.

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