Diagnostic Errors and Malpractice Claims

What’s behind a recent surge in malpractice claims related to diagnostic errors? Ophthalmic Mutual Insurance Company (OMIC) experts discussed the topic at a special forum on Sunday.

Retina most common. Retina claims accounted for 84 of 233 OMIC claims filed in a 7-year period. And retinal detachments were the largest single problem (65 of 84 claims). “Common issues included no dilated exam, no differential diagnosis, and a diagnosis that did not account for or match symptoms,” said Anne M. Menke, RN, PhD. With regard to payments, the bulk (6 claims, 47% of payments) were for retinopathy of prematurity cases.

Parsing the problem. Diagnostic errors rarely involve exotic or unusual conditions, Dr. Menke said. “It’s more likely to involve an inadequate evaluation, cognitive errors, or delays in referral,” she said. In other words, the problem tends to be the physician.

Fast versus slow thinking. Fast thinking, honed by training and experience, allows physicians to move quickly and decisively. But slow thinking—what Dr. Menke termed “deliberative thinking”—can save a physician from making critical mistakes. “Get a second opinion from yourself. Take a diagnostic time out, and ask yourself, ‘Could this be something else? If I’m wrong, what don’t I want this to be?’”

Legal advice. In analyzing several cases presented by the OMIC team, Michelle R. Schwartz, Esq., a lawyer who practices in Las Vegas, made the following points.

• “Think about where your documentation is ultimately going to end up. Document why you are making the choices you’re making.” She added, “You can certainly testify with regard to your actions, but your actions need to be documented.” This extends to all telephone communication, medication charting, and intraoffice communication regarding patient care.
• Dealing with noncompliance. “If you have a patient who is clearly noncompliant, you need to document your plan of care,” Ms. Schwartz said.
• EHR issues. Be sure to reread your EHR notes before you electronically sign them, Ms. Schwartz said—and be aware that carryover issues can result in incomplete documentation. “You can be on the stand and say, ‘I remember x,’ but that’s not what your EHR record says.” She emphasized, “Don’t make your motives and integrity an issue; take an extra couple of minutes to go back and reread your notes and documentation. Don’t give an attorney room to claim that EHR information was altered.”—Jean Shaw

If you have questions for OMIC staff, you can visit them at AAO 2015 (Hall B, Booth 3432) or go to www.omic.com.

Financial disclosures. Dr. Menke—OMIC: E.
Ms. Schwartz—None.
 
Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.