Study finds physicians fear patient harm more than legal action as result of medical error

ED attending physicians and advanced practice clinicians had a greater fear of patient harm than legal action in the event of a medical error, a recent study found.

“Malpractice litigation is a major concern when medical errors result in adverse patient outcomes,” Daniel Ostrovsky, BMedSc, of the Soroka Clinical Research Center at Ben-Gurion University of the Negev in Israel, and colleagues wrote in JAMA Network Open. “Fear of malpractice has been associated with excessive health care use through defensive medicine, whereby additional testing or referrals are made to protect physicians from malpractice accusations.”

The researchers noted that previous studies have examined how legal concerns impact clinician decision-making, but concerns regarding patient harm is less documented, “which might be a stronger impetus for excessive testing.”

According to StatPearls, around 400,000 hospitalized patients experience some kind of preventable harm each year. Meanwhile, 40,000 to 60,000 patients experience death or injury due to missed diagnosis, with one in 1,000 primary care visits resulting in preventable harm.

For the study, Ostrovsky and colleagues surveyed 1,222 ED attending physicians and advanced practice clinicians (mean age, 43 years; 54.2% men) from January 2020 to September 2020.

The respondents used a Likert scale of 1 (strongly disagree) to 6 (strongly agree) to indicate their agreement of:

• how fearful they are of making a mistake that results in harm to the patient during their day-to-day practice; and
• how fearful they are of making a mistake that results in being sued.

Ostrovsky and colleagues found that the mean score for fear of harm was greater than the fear of practice litigation (4.4 vs. 3.4), with modal responses for fear of harm being “moderately agree” compared with “slightly agree” for fear of suit (31.1% vs. 29.1%).

Mean fear of harm scores before the COVID-19 pandemic were similar to those after the pandemic (4.42 vs. 4.39), which was additionally the case with fear of suit (3.41 before vs. 3.38 after).

When mean fear of harm scores were adjusted in multivariable linear regressions, the researchers reported differences between respondents with 5 to 14 years of experience (P = .009) and 15 to 44 years of experience (P < .001) vs. those with 0 to 4 years’ experience, and differences between male vs. female respondents (P = .03).

Ostrovsky and colleagues noted that the findings are relevant to defensive medicine, and contrast with previous studies that implied fear of lawsuit was the driving factor in excessive testing.

“Although the study did not delineate the association between this concern and potential overuse of testing, it suggested that fear of harm should be considered with, and may be more consequential than, fear of suit in medical decision-making,” they wrote, recommending further research to determine the role both fears play in decision-making.

References:

• Medical error reduction and prevention. https://www.ncbi.nlm.nih.gov/books/NBK499956/. Accessed Nov. 16, 2022.
• Perspectives of emergency clinicians about medical errors resulting in patient harm or malpractice litigation. https://www.eurekalert.org/news-releases/970702. Published Nov. 11, 2022. Accessed Nov. 15, 2022.
• Ostrovsky D, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.41461.