Patel Richa, Rynecki Nicole, Eidelman Eric, Maddukuri Spandana, Ayyaswami Varun, Patel Manthan, Gupta Raghav, Prabhu Arpan V, Magnani Jared
Medicine, Rutgers University New Jersey Medical School, Newark, USA.
Medicine, University of Maryland School of Medicine, Baltimore, USA.
Cureus. 2019 Jul 28;11(7):e5259. doi: 10.7759/cureus.5259.
Introduction Physicians are increasingly practicing defensive medicine as a response to society's litigious climate. This study sought to characterize cardiology malpractice claims and elucidate the allegations underlying the use of defensive medicine. Methods The WestlawNext™ database was queried to obtain state and federal jury verdicts and settlements related to medical malpractice and cardiology that occurred in the United States between 2010 and 2015. Cardiology cases were identified using the search terms "medical malpractice" and "cardiology" and reviewed by two individuals utilizing available case documents. Duplicate and nonpertinent cases were excluded. Binary logistic regression models were created to predict the likelihood of defendant verdict, plaintiff verdict, and settlement based on the various reasons for litigation cited. Results Inclusion criteria were met in 166 cases. The plaintiffs were predominantly male (94 cases; 56.6%), and the average patient age was 53.3±17.5 years. More than half of the cases involved a cardiologist as a defendant. The most common reasons for litigation were: failure to treat (129; 77.7%), failure to diagnose (115; 69.3%), failure to refer/order diagnostic tests (107; 64.5%), and patient death (118; 71.1%). Among cases tried for failure to diagnose, the most commonly missed diagnosis was myocardial infarction. Cases most commonly resulted in a defendant verdict (94; 56.6%). However, odds of a plaintiff verdict were significantly higher when failure to diagnose was alleged with an odds ratio (OR) of 7.60 (95% confidence interval 1.14 - 50.87, p = 0.0365). Conclusions Failure to diagnose remains a commonly alleged base for litigation. In conclusion, our analysis suggests increased training for non-cardiologists in the recognition of the acute coronary syndrome and enhanced awareness of inherent biases among all physicians may facilitate reducing missed diagnoses.
引言 作为对社会诉讼风气的回应，医生越来越多地采取防御性医疗行为。本研究旨在描述心脏病学医疗事故索赔的特征，并阐明防御性医疗行为背后的指控。方法 查询WestlawNext™数据库，以获取2010年至2015年期间在美国发生的与医疗事故和心脏病学相关的州和联邦陪审团裁决及和解协议。使用搜索词“医疗事故”和“心脏病学”识别心脏病学病例，并由两人利用可用的病例文件进行审查。排除重复和不相关的病例。基于所引用的各种诉讼原因，创建二元逻辑回归模型来预测被告胜诉、原告胜诉和和解的可能性。结果 166例符合纳入标准。原告以男性为主（94例；56.6%），患者平均年龄为53.3±17.5岁。超过一半的案件涉及心脏病专家作为被告。最常见的诉讼原因是：治疗不当（129例；77.7%）、诊断失误（115例；69.3%）、未转诊/未安排诊断检查（107例；64.5%）和患者死亡（118例；71.1%）。在因诊断失误而受审的案件中，最常漏诊的是心肌梗死。案件最常见的结果是被告胜诉（94例；56.6%）。然而，当指控诊断失误时，原告胜诉的几率显著更高，优势比（OR）为7.60（95%置信区间1.14 - 50.87，p = 0.0365）。结论 诊断失误仍然是常见的诉讼指控依据。总之，我们的分析表明，加强非心脏病专家对急性冠状动脉综合征的识别培训，提高所有医生对固有偏见的认识，可能有助于减少漏诊。
