Malpractice Claims of Internal Medicine Involving Diagnostic and System Errors in Japan

Abstract

Objectives Medical litigation resulting from diagnostic errors leads to lawsuits that are time-consuming, expensive, and psychologically burdensome. Few studies have focused on internists, who are more likely to make diagnostic errors than others, with assessments of litigation in terms of system and diagnostic errors. This study explored factors contributing to internists losing lawsuits and examined whether system or diagnostic errors were more important on the outcome. Methods Data regarding 419 lawsuits against internists closed between 1961 and 2017 were extracted from a public Japanese database. Factors affecting litigation outcomes were identified by comparative analysis focusing on system and diagnostic errors, environmental factors, and differences in initial diagnoses. Results Overall, 419 malpractice claims against internists were analyzed. The rate of lawsuits being decided against internists was high (50.1%). The primary cause of litigation was diagnostic errors (213, 54%), followed by system errors (188, 45%). The foremost initial diagnostic error was "no abnormality" (17.2%) followed by ischemic heart disease (9.6%) and malignant neoplasm (8.1%). Following cause-adjustment for loss, system errors were 21.37 times more likely to lead to a loss. Losses were 6.26 times higher for diagnostic error cases, 2.49 times higher for errors occurring at night, and 3.44 times higher when "malignant neoplasm" was the first diagnosis. Conclusions This study found that system errors strongly contributed to internists' losses. Diagnostic errors, night shifts, and initial diagnoses of malignant neoplasms also significantly affected trial outcomes. Administrators must focus on both system errors and diagnostic errors to enhance the safety of patients and reduce internists' risk exposure.

Impact of System and Diagnostic Errors on Medical Litigation Outcomes: Machine Learning-Based Prediction Models

“…Other predictive factors for an accepted claim (medical doctors' loss) using LightGBM were diagnostic error, reason for litigation (diagnosis), facility size, and patient age. These results are consistent with those of previous studies on internal medicine and orthopedic surgery [5,8,12]. Various previous studies have estimated that physician diagnostic errors in the outpatient setting may range from 3-10%, and the negative impact of diagnostic errors is a significant and urgent problem that needs to be addressed [9,30].…”

“…It is better for medical staff to understand the factors that influence litigation outcomes [3,4]. System and diagnostic errors have been reported as contributing factors to malpractice claims [5][6][7][8] and recently recognized as essential issues in medical economics, health care quality, and patient safety [9,10]. In addition, previous studies have indicated the following factors associated with litigation outcomes: night shift, unnecessary surgery, sequelae, and death [5,8,11,12].…”

Future Research in General Medicine Has Diverse Topics and is Highly Promising: Opinions Based on a Questionnaire Survey

“… 12 , 13 In-depth evaluation of diagnostic errors from the viewpoint of the professional can improve quality of clinical care. 14 , 15 Numerous case reports on diagnostic errors as resources to improve the quality of diagnosis have been published in Japan, and research is being conducted on the epidemiology of diagnostic errors, 15 , 16 diagnostic error education, 17 clinical prediction rules, artificial intelligence (AI)-based diagnosis, 18 and diagnostic concepts. 19 Generalists working in various settings may discover research interests in the course of their daily clinical practice.…”

Medical malpractice and gastrointestinal endoscopy

“…However, the trajectory of evaluation prior to ordering the first diagnostic test can be influenced by cognitive biases, such as anchoring or premature closure [33]. Other analyses have further distinguished cognitive and system-related error among subcategories of diagnostic error [34,35]. Knowledge deficits, inadequate data gathering, and incomplete synthesis also contributed to cognitive error.…”