Ely J W, Dawson J D, Young P R, Doebbeling B N, Goerdt C J, Elder N C, Olick R S
Department of Family Medicine, University of Iowa College of Medicine, Iowa City, USA.
J Fam Pract. 1999 Jan;48(1):23-30.
Physicians who have been sued multiple times for malpractice are assumed to be less competent than those who have never been sued. However, there is a lack of data to support this assumption. Competence includes both knowledge and performance, and there are theoretical reasons to suspect that the most knowledgeable physicians may be sued the most.
We conducted a retrospective cohort study of family physicians who were included in the Florida section of the 1996 American Medical Association's Physician Masterfile and who practiced in Florida at any time between 1971 and 1994 (N = 3686). The main outcome was the number of malpractice claims per physician adjusted for time in practice. Using regression methods, we analyzed associations between malpractice claims and measures of physician knowledge.
Risk factors for malpractice claims included graduation from a medical school in the United States or Canada (incidence rate ratio [IRR] 1.8; 95% confidence interval [CI], 1.6-2.1), specialty board certification (IRR 1.8; 95% CI, 1.6-2.1), holding the American Medical Association Physician's Recognition Award (IRR 1.4; 95% CI, 1.2-1.7), and Alpha Omega Alpha Honor Society membership (IRR 1.8; 95% CI, 1.1-3.0). Among board-certified family physicians, sued physicians who made no payments to a plaintiff had higher certification examination scores than nonsued physicians (53.48 vs 51.38, P < .01). The scores of sued physicians who made payments were similar to those of nonsued physicians (51.05 vs 51.38, P = .93).
Among Florida family physicians, the frequency of malpractice claims increased with evidence of greater medical knowledge.
多次因医疗事故被起诉的医生被认为比从未被起诉的医生能力更差。然而，缺乏数据支持这一假设。能力包括知识和表现，并且有理论依据怀疑知识最丰富的医生可能被起诉的次数最多。
我们对1996年美国医学协会医生主档案佛罗里达部分中列出的、在1971年至1994年期间任何时间在佛罗里达执业的家庭医生进行了一项回顾性队列研究（N = 3686）。主要结果是根据执业时间调整后的每位医生的医疗事故索赔数量。我们使用回归方法分析了医疗事故索赔与医生知识衡量指标之间的关联。
医疗事故索赔的风险因素包括毕业于美国或加拿大的医学院（发病率比[IRR] 1.8；95%置信区间[CI]，1.6 - 2.1）、专业委员会认证（IRR 1.8；95% CI，1.6 - 2.1）、获得美国医学协会医生认可奖（IRR 1.4；95% CI，1.2 - 1.7）以及成为阿尔法欧米伽阿尔法荣誉学会会员（IRR 1.8；95% CI，1.1 - 3.0）。在获得委员会认证的家庭医生中，未向原告支付赔偿的被起诉医生的认证考试成绩高于未被起诉的医生（53.48对51.38，P <.01）。支付赔偿的被起诉医生的成绩与未被起诉的医生相似（51.05对51.38，P =.93）。
在佛罗里达的家庭医生中，医疗事故索赔的频率随着医学知识水平的提高而增加。
