Medical Insurance

Jason Maude jason.maude at ISABELHEALTHCARE.COM
Tue Nov 22 10:03:58 UTC 2016


This is a very useful- many thanks for drawing it to our attention.

One interesting item is the legal view on a differential diagnosis. We are often asked by clinicians whether they would be more or less liable if they used a DDx Generator to help put together a differential.

The CPMA states on its site "Courts view the formulation and documentation of a differential diagnosis as evidence of a physician's competence, prudence, and thoughtfulness."

I assume that would be the same across most jurisdictions.

Regards

Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
www.isabelhealthcare.com<http://www.isabelhealthcare.com/>

From: "Wallace, Dr. Gordon[CMPA]" <GWallace at CMPA.ORG<mailto:GWallace at CMPA.ORG>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, "Wallace, Dr. Gordon[CMPA]" <GWallace at CMPA.ORG<mailto:GWallace at CMPA.ORG>>
Date: Monday, 21 November 2016 22:17
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] Medical Insurance

At the recent Error in Diagnosis conference in Los Angeles, representatives from the PIAA group of insurance companies presented on the educational programs they are running to improve diagnostic accuracy. Diagnostic error is the number one liability issue for both American and Canadian physicians. Even for the procedure-based surgical specialties, diagnosis is the second most frequent issue resulting in claims.The surgical specialties experience medico-legal problems related to delays in diagnosing complications in the post-operative period of care.

Dr. Benzoni is correct in pointing out that litigation alone seldom directly results in improvement in healthcare. However, the importance of learning from medical-legal cases is increasingly recognized. For example, the recent Institute of Medicine report Improving Diagnosis in Health Carepublished in 2015 indicates diagnostic error occurs 5 to 15% of the time and many believe that is an underestimate. Recommendation 6D of the report states: Professional liability insurance carĀ­riers and captive insurers should collaborate with health care professionals on opportunities to improve diagnostic performance through education, training, and practice improvement approaches and increase participation in such programs.

The Canadian Medical Protective Association (CMPA) has a unique national database of civil legal actions and regulatory complaints, and researches these to identify problems in patient care for all specialties including family medicine.  The diagnostic issues that the CMPA sees are generally very serious often representing illnesses with catastrophic outcomes unless diagnosed early. Failures relate to knowledge, poor assessments and physical examination, inappropriate testing, problems in differential diagnosis including the role of cognitive biases, communication including lost reports and failure to follow up.

We have considerable information on our website:
The CMPA GOOD PRACTICES GUIDE has material on diagnosis in several sections, both in the Student and Faculty sections:
Managing diagnostic risk:
http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/manage_risk/The_diagnostic_process/steps_to_diagnosis-e.html

The Diagnostic tips section is a sum of what we have learned:
http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/manage_risk/Diagnostic_tips/the_cmpas_experience-e.html

We deal with Cognitive biases under Human Factors (Pat Croskerry helped here)
http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/influences_on_reasoning-e.html

Faculty materials for teaching the core content are available at http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/manage_risk/manage_risk-faculty-e.html
And at http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/human_factors/human_factors-faculty-e.html

Hope this helps

Gord Wallace

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Dr. Gordon Wallace, FRCPC
Managing Director |Safe Medical Care
875 Carling Ave., Ottawa,  ON  K1S 5P1
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The CMPA Good Practices Guide is available in English at: cmpa-acpm.ca/gpg <http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/index/index-e.html>  and in French at: cmpa-acpm.ca/gbp<http://www.cmpa-acpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/index/index-f.html>.
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From: Tom Benzoni [mailto:benzonit at GMAIL.COM]
Sent: Monday, November 21, 2016 3:46 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Medical Insurance

Short reply:
There is an extensive literature that the litigation does nothing to improve health care and it is not intended to so do.
There is not corollary between commission/omission of malpractice and outcome as measured by physicians blinded to the trial outcome.
There is a direct corollary between income of the patient and likelihood of making it into the courthouse.
Simple test:
If there is a corollary between malpractice and skill, lost cases should be evenly distributed.
If there is a corollary, OB, Neurosurgeons and ER must be the worst practitioners.
Our current system is not civil but criminal. (That's not commentary, it's analysis of the process.) (Say if you want more.)
I have only seen 1 case that resulted in improvement and I don't know, I just guess, that the outreach was the result of a case instead of an advocacy/outreach. Research Tyler Kahle Story. I use this effort in education to this day.
tom benzoni
(practicing ER doc)

On Mon, Nov 21, 2016 at 9:56 AM, Robert Bell <0000000296e45ec4-dmarc-request at list.improvediagnosis.org<mailto:0000000296e45ec4-dmarc-request at list.improvediagnosis.org>> wrote:
What role does the medical litigation insurance industry in the US play in preventing errors in medicine? Are the programs effective? What are the programs they have today? What works? Could things be improved? Is anything directed towards errors in diagnosis?

Rob Bell, M.D.

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