Serious medical errors that result in malpractice payments are almost as common in outpatient settings like physicians' offices and urgent care clinics as they are in hospitals, according to a recent study published in JAMA.
Of nearly 11,000 malpractice claims paid on behalf of doctors in 2009, 48 percent were for problems that occurred in hospitals, while 43 percent were for outpatient errors (another 9 percent occurred in both settings).
Unlike hospitals, however, where surgical errors were the No. 1 reason for adverse events that led to malpractice payouts, in outpatient settings, the study found, there was a very different culprit: diagnostic errors.
This makes some sense since much of what happens in doctors' offices and clinics is related to trying to figure out what's wrong with patients.
What causes diagnostic errors and how to avoid them is a subject of growing interest among researchers and policymakers. One oft-cited study of diagnostic errors in the outpatient setting that was published in the Annals of Internal Medicine in 2006 found that usually misdiagnoses were the result of multiple errors. The most common breakdowns were failure to order appropriate diagnostic tests and failure to create a proper follow-up plan.
Why did the errors occur? Physician failures in judgment, vigilance, memory or knowledge were the top factors that led to problems.
As a patient, there's little you can do to prevent poor judgment, for example, or a lapse of memory on the part of your physician that leads to a medical error. But there are steps that patients can take, especially in the outpatient setting, to help minimize errors, say experts. The lead author of the JAMA study, Dr. Tara Bishop, suggests the following:
- Unlike hospitals, where things happen quickly and patients may not know what's being done to them, in an outpatient setting patients can and should make the effort to know what medical tests and treatments are being performed, and why.
- Follow up to get the results of tests that have been ordered.
- If necessary, get copies of test and treatment results and send them to other practitioners who are involved with your care.
- Carry an updated list of the medications you take with you at all times and share it with all your doctors.
- Make sure you feel comfortable talking with your doctor and asking questions. If you don't feel comfortable, find another doctor.
Bishop is a busy researcher. She and some colleagues just published another paper that finds doctors are more likely to stop taking new patients with private insurance than those covered by Medicare.