McLean Thomas R
Third Millennium Consultants, LLC, 4970 Park, Shawnee, KS 66216, USA.
Chest. 2004 Nov;126(5):1672-9. doi: 10.1378/chest.126.5.1672.
Minimal information exists on why malpractice actions are filed against physicians who treat lung cancer.
To review currently available data on lung cancer malpractice litigation to develop litigation-avoidance strategies.
A retrospective review of a publicly available database containing verdicts and settlements of malpractice cases. Data were then compared to the Physician Insurers Association of America (PIAA) Lung Cancer Study, which was published in 1992. The PIAA report is considered the best available data on malpractice and lung cancer.
There were 89 patients in the current study and 213 patients in the PIAA study. Physicians are most often sued by patients in their 50s (mean age, 58.9 years; range, 34 to 80 years [current study]; vs 55 years; range, 17 to 75 years [PIAA study]). Primary care physicians (60% cases in the current study vs 33% cases in the PIAA study) and radiologists (20% cases in the current study vs 55% cases in the PIAA study) were named as defendants in > 75% of suits. Failure to diagnosis lung cancer was the most common reason physicians were sued (80% case in the current study vs 23.3% cases in the PIAA series). Despite the similarity in litigation profiles, the mean award to plaintiffs, in constant dollars, increased from $172,271 in the PIAA study to $632,261 in the current study.
(1) Recommended strategies to avoid litigation depend on physician subspecialties. While primary care physicians would benefit most from setting up a chest radiograph tracking system, radiologists would benefit most from initiating a continuous quality improvement system to substantially decrease the misinterpretation rate of chest radiographs. (2) Over the past 12 years, there appears to have been a substantial increase in awards to patients with lung cancer who sue their physicians. However, this finding may be artificial because of differing study design. Further investigation on this subject is recommended.
关于针对肺癌治疗医生提起医疗事故诉讼的原因，现有信息极少。
回顾目前可获取的有关肺癌医疗事故诉讼的数据，以制定避免诉讼的策略。
对一个公开可用数据库进行回顾性分析，该数据库包含医疗事故案件的裁决和和解情况。然后将数据与1992年发表的美国医师保险协会（PIAA）肺癌研究进行比较。PIAA报告被认为是关于医疗事故和肺癌的最佳可用数据。
本研究中有89名患者，PIAA研究中有213名患者。医生最常被50多岁的患者起诉（平均年龄58.9岁；范围34至80岁[本研究]；对比PIAA研究中的55岁；范围17至75岁）。在超过75%的诉讼中，初级保健医生（本研究中占60%的案件，对比PIAA研究中的33%）和放射科医生（本研究中占20%的案件，对比PIAA研究中的55%）被列为被告。未能诊断出肺癌是医生被起诉的最常见原因（本研究中占80%的案件，对比PIAA系列中的23.3%）。尽管诉讼情况相似，但以不变美元计算，原告的平均赔偿额从PIAA研究中的172,271美元增加到了本研究中的632,261美元。
（1）推荐的避免诉讼策略取决于医生的亚专业。虽然初级保健医生通过建立胸部X光片追踪系统获益最大，但放射科医生通过启动持续质量改进系统以大幅降低胸部X光片的误读率获益最大。（2）在过去12年中，起诉医生的肺癌患者获得的赔偿似乎大幅增加。然而，由于研究设计不同，这一发现可能并不真实。建议对该主题进行进一步调查。
