A series of abstracts selected from pubmed returns for "malpractice," limited to "clinical trials".
Something for Rich (FYI buddy, I'd be happy to try to tell you if and when something is needed in the future. Some of it is overcharge (eg come in for oil change every 3k when the driver's manual says 5k) and some is intellectual laziness / practice inertia; some is also defensive.
Radiology. 2005 Jul;236(1):37-46. Related Articles, Links
Does litigation influence medical practice? The influence of community radiologists' medical malpractice perceptions and experience on screening mammography.
Elmore JG, Taplin SH, Barlow WE, Cutter GR, D'Orsi CJ, Hendrick RE, Abraham LA, Fosse JS, Carney PA.
Dept of Internal Medicine, Univ of Washington School of Medicine, Harborview Medical Ctr, 325 Ninth Ave, Box 359780, Seattle, WA 98104-2499, USA. email@example.com
PURPOSE: To assess the relationship between radiologists' perception of and experience with medical malpractice and their patient-recall rates in actual community-based clinical settings. MATERIALS AND METHODS: All study activities were approved by the institutional review boards of the involved institutions, and patient and radiologist informed consent was obtained where necessary. This study was performed in three regions of the United States (Washington, Colorado, and New Hampshire). Radiologists who routinely interpret mammograms completed a mailed survey that included questions on demographic data, practice environment, and medical malpractice. Survey responses were linked to interpretive performance for all screening mammography examinations performed between January 1, 1996, and December 31, 2001. The odds of recall were modeled by using logistic regression analysis based on generalized estimating equations that adjust for study region. RESULTS: Of 181 eligible radiologists, 139 (76.8%) returned the survey with full consent. The analysis included 124 radiologists who had interpreted a total of 557 143 screening mammograms. Approximately half (64 of 122 [52.4%]) of the radiologists reported a prior malpractice claim, with 18 (14.8%) reporting mammography-related claims. The majority (n = 51 [81.0%]) of the 63 radiologists who responded to a question regarding the degree of stress caused by a medical malpractice claim described the experience as very or extremely stressful. More than three of every four radiologists (ie, 94 [76.4%] of 123) expressed concern about the impact medical malpractice has on mammography practice, with over half (72 [58.5%] of 123) indicating that their concern moderately to greatly increased the number of their recommendations for breast biopsies. Radiologists' estimates of their future malpractice risk were substantially higher than the actual historical risk. Almost one of every three radiologists (43 of 122 [35.3%]) had considered withdrawing from mammogram interpretation because of malpractice concerns. No significant association was found between recall rates and radiologists' experiences or perceptions of medical malpractice. CONCLUSION: U.S. radiologists are extremely concerned about medical malpractice and report that this concern affects their recall rates and biopsy recommendations. However, medical malpractice experience and concerns were not associated with recall or false-positive rates. Heightened concern of almost all radiologists may be a key reason that recall rates are higher in the United States than in other countries, but this hypothesis requires further study. Copyright RSNA, 2005
Here's something that's no surprise and suggests the best way to avoid lawsuits:
Gerontologist. 2004 Jun;44(3):339-47. Related Articles, Links
Factors predicting lawsuits against nursing homes in Florida 1997-2001.
Johnson CE, Dobalian A, Burkhard J, Hedgecock DK, Harman J.
Rehabilitation Outcomes Research Center of Excellence, Gainsville, Fl 32608-1197, USA. Christopher.Johnson4@med.va.gov
PURPOSE: We explore how nursing home characteristics affect the number of lawsuits filed against the facilities in Florida during the period from 1997 to 2001. DESIGN AND METHODS: We examined data from 478 nursing homes in 30 Florida counties from 1997 to 2001. We obtained the data from Westlaw's Adverse Filings: Lawsuits database, the Online Survey, Certification, and Reporting system database from the Centers for Medicare and Medicaid Services, and state complaint surveys, and we also used primary data. We used negative binomial regression to explain total lawsuit variance by year. We controlled for acuity and year effects, and our explanatory variables included (a) facility characteristics--including staffing, number of beds, multistate system membership, and for-profit ownership--and (b) quality measures--including total number and type of state licensing survey deficiencies, pressure-sore development, and medication errors per resident. RESULTS: Higher registered nurse and certified nursing assistant staffing levels were associated with fewer lawsuits. More deficiencies on the licensing survey and larger and for-profit nursing homes were positively related with higher numbers of lawsuits. IMPLICATIONS: This study suggests that nursing homes that meet long-stay staffing standards, meet minimum quality measures, are not for profit, and are smaller will experience fewer lawsuits. Copyright 2004 The Gerontological Society of America
This tells us much the same, although its interesting to note that "noncompliance explains A THIRD of cases." The rest?
Obstet Gynecol. 2003 Apr;101(4):751-5. Related Articles, Links
Reduced medicolegal risk by compliance with obstetric clinical pathways: a case--control study.
Ransom SB, Studdert DM, Dombrowski MP, Mello MM, Brennan TA.
Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Bloomfield Hills, Michigan 48301, USA. firstname.lastname@example.org
OBJECTIVE: To estimate whether guideline compliance affected medicolegal risk in obstetrics and whether malpractice claims data can provide useful information on guideline noncompliance by focusing on the claims experience of a large health system delivering approximately 12000 infants annually. METHODS: We retrospectively identified 290 delivery-related (diagnosis-related groups 370-374) malpractice claims and 262 control deliveries at the health system during the period from 1988 to 1998. Clinical pathways for vaginal and cesarean delivery implemented in 1998 were used as a "standard of care." We compared rates of noncompliance with the pathways in the claims and control groups, calculated an odds ratio for increased risk of being sued given departure from the guideline standards, and calculated the elevated risk of litigation introduced by noncompliance. We also compared the frequencies of different types of departures across claims and control groups. RESULTS: Claims closely resembled controls on several descriptive measures (mother's age, location of delivery, type of delivery, and complication rates), but noncompliance with the clinical pathway was significantly more common among claims than controls (43.2% versus 11.7%, P <.001; odds ratio = 5.76, 95% confidence interval 3.59, 9.2). In 81 (79.4%) of the claims involving noncompliance with the pathway, the main allegation in the claim related directly to the departure from the pathway. The excess malpractice risk attributable to noncompliance explained approximately one third (104 of 290) of the claims filed (attributable risk = 82.6%). There were no significant differences in the types of deviation from the guidelines across claims and control groups. CONCLUSION: In addition to reducing clinical variation and improving clinical quality of care, adherence to clinical pathways might protect clinicians and institutions against malpractice litigation. Malpractice data might also be a useful resource in understanding breakdowns in processes of care.
Here's some empiric evidence of what I said about MD-patient relationships:
West J Med. 2000 Oct;173(4):244-50. Related Articles, Links
Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions.
Moore PJ, Adler NE, Robertson PA.
Department of Psychology George Washington University School of Medicine 2125 G St NW Washington, DC 20052, USA. email@example.com
OBJECTIVE: To examine the causal effects of doctor-patient relations and the severity of a medical outcome on medical patient perceptions and malpractice intentions in the event of an adverse medical outcome. DESIGN: Randomized between-subjects experimental design. Patients were given scenarios depicting interactions between an obstetric patient and her physician throughout the patient's pregnancy, labor, and delivery. PARTICIPANTS: One hundred twenty-eight postpartum obstetric patients were approached for participation, of whom 104 completed the study. Main outcome measures Patients' perceptions of physician competence and intentions to file a malpractice claim. RESULTS: Positive physician communication behaviors increased patients' perceptions of physician competence and decreased malpractice claim intentions toward both the physician and the hospital. A more severe outcome increased only patients' intentions to sue the hospital. CONCLUSION: These results provide empiric evidence for a direct, causal effect of the doctor-patient relationship on medical patients' treatment perceptions and malpractice claim intentions in the event of an adverse medical outcome.