Shimane University Hospital, Postgraduate Clinical Training Center, Japan.
Harvard Medical School, Master of Healthcare Quality and Patient Safety, USA.
Intern Med. 2021 Sep 15;60(18):2919-2925. doi: 10.2169/internalmedicine.6652-20. Epub 2021 Mar 29.
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.
由于诊断错误导致的医疗诉讼会引发耗时、昂贵且心理负担沉重的诉讼。很少有研究关注内科医生，他们比其他医生更容易犯诊断错误，并评估系统和诊断错误方面的诉讼。本研究探讨了导致内科医生败诉的因素，并研究了系统或诊断错误对结果的影响是否更大。
从一个公共的日本数据库中提取了 1961 年至 2017 年间针对内科医生的 419 起诉讼案件的数据。通过比较分析，重点关注系统和诊断错误、环境因素以及初始诊断的差异，确定影响诉讼结果的因素。
总共分析了 419 起针对内科医生的医疗事故诉讼。内科医生败诉的比例很高（50.1%）。诉讼的主要原因是诊断错误（213 起，占 54%），其次是系统错误（188 起，占 45%）。首要的初始诊断错误是“无异常”（17.2%），其次是缺血性心脏病（9.6%）和恶性肿瘤（8.1%）。在进行损失调整后，系统错误导致败诉的可能性增加了 21.37 倍。诊断错误导致败诉的可能性增加了 6.26 倍，夜间发生错误的可能性增加了 2.49 倍，初次诊断为“恶性肿瘤”的可能性增加了 3.44 倍。
本研究发现系统错误是内科医生败诉的主要原因。诊断错误、夜班和恶性肿瘤的初始诊断也显著影响审判结果。管理人员必须关注系统错误和诊断错误，以提高患者的安全性并降低内科医生的风险暴露。
