A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments

Abstract

BackgroundThe aim of this study was to review the typical factors related to physician’s liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain.MethodsThis study involved analyzing 366 medical litigation case reports from 1990 through 2008 where the duty to explain was disputed. We examined relationships between patients, physicians, variables related to physician’s explanations, and physician’s breach of the duty to explain by comparing mean values and percentages in obstetrics and gynecology, internal medicine, and surgical departments with the t-test and χ2 test.ResultsWhen we compared the reasons for decisions in cases where the patient won, we found that the percentage of cases in which the patient’s claim was recognized was the highest for both physician negligence, including errors of judgment and procedural mistakes, and breach of the duty to explain, in obstetrics and gynecology departments; breach of the duty to explain alone in internal medicine departments; and mistakes in medical procedures alone in surgical departments (p = 0.008). When comparing patients, the rate of death was significantly higher than that of other outcomes in precedents where a breach of the duty to explain was acknowledged (p = 0.046). The proportion of cases involving obstetrics and gynecology departments, in which care was claimed to be substandard at the time of treatment, and that were not argued as breach of a duty to explain, was significantly higher than those of other evaluated departments (p <0.001). However, internal medicine and surgical departments were very similar in this context. In obstetrics and gynecology departments, the proportion of cases in which it had been conceded that the duty to explain had been breached when seeking patient approval (or not) was significantly higher than in other departments (p = 0.002).ConclusionIt is important for physicians working in obstetrics and gynecology departments to carefully explain the risk of death associated with any planned procedure, and to obtain genuinely informed patient consent.

Debunking the myth that the majority of medical errors are attributed to communication

“…8,[14][15][16][17][18][19][20][21][22][23][24][25] Failings in assessment and diagnosis typically included errors of judgement. 16,[24][25][26][27][28] Yamada et al 25 observed 780 algorithmdriven tasks and found that 194 of them (error rate of 23%) were completed incorrectly. They noted that 72% of all errors were errors of commission and 28% were errors of omission.…”

Litigations in Obstetric and Gynecological Practice: Can it be prevented? A Probability to Possibility

“…In Japan both maternal and perinatal mortality rates remain low, and healthcare safety in obstetrics and gynecology department is considered to be excellent from a global perspective, and despite such good care, the percentages of medical negligence cases filed against obstetricians are increasing [7]. Issues related to pregnancy and child birth attracts more law suits as pregnancy is believed to be a physiological process, and any deviation from normal is considered to be abnormal [8].…”

Estudio de las compensaciones económicas sobre sentencias contra obstetras y ginecólogos en España (1987-2013)

“…Regarding obstetrics and gynaecology in developed countries, despite low maternal and infant mortality rates and the fact that safety in specialty departments is considered excellent, complaints against gynaecologists continue to rise, especially when compared with other specialties. 19 The most common grounds leading to these claims, however, are the same throughout the world: neonatal encephalopathy, errors in prenatal diagnosis, shoulder dystocia, and errors in the screening of certain diseases. 16 Another reason people focus on complaints against gynaecologists is their influence on changing attitudes in specific aspects of childbirth, which has led to an unjustified increase in the rate of Caesarean sections and low rates of assisted delivery.…”