I recently became aware of a very interesting article about malpractice cases related to primary care practices. It is called, "Missed and Delayed Diagnoses in the Ambulatory Setting: A Study of Closed Malpractice Claims", from the Annals of Internal Medicine, by Dr. Tejal K. Gandhi and several other other authors. (3 October 2006, Volume 145, Issue 7, Pages 488-496).
The authors reviewed 307 closed malpractice claims from four malpractice insurance companies in which patients alleged a missed or delayed diagnosis in the ambulatory setting. I quote from the abstract:
A total of 181 claims (59%) involved diagnostic errors that harmed patients. Fifty-nine percent (106 of 181) of these errors were associated with serious harm, and 30% (55 of 181) resulted in death. The most common breakdowns in the diagnostic process were failure to order an appropriate diagnostic test (100 of 181 [55%]), failure to create a proper follow-up plan (81 of 181 [45%]), failure to obtain an adequate history or perform an adequate physical examination (76 of 181 [42%]), and incorrect interpretation of diagnostic tests (67 of 181 [37%]). The leading factors that contributed to the errors were failures in judgment (143 of 181 [79%]), vigilance or memory (106 of 181 [59%]), knowledge (86 of 181 [48%]), patient-related factors (84 of 181 [46%]), and handoffs (36 of 181 [20%]).
Recognizing that malpractice claims are but a subset of cases that result in medical errors or other patient safety problems, this study to me is nonetheless another indication of an important problem that other observers and I have mentioned. The first line of defense in proper patient care is the primary care system, yet this portion of health care delivery is systematically undercompensated and undervalued in the medical payment spectrum. We have relegated primary care doctors to a triage function, requiring them to see a large number of patients in a short period of time. It should come as no surprise that the kinds of errors mentioned in this article happen when a PCP is expected to spend about 20 minutes with each patient.
Much is often made about the superiority of the health care system in European countries. I believe a big portion of the difference is the relative emphasis put on primary care in those countries compared to our own.