Even One Paid Malpractice Claim Predicts More in the Future
Physicians with even one single paid malpractice claim are much more likely than those with no paid claims to experience more paid claims later, according to a recent study.
Researchers examined all paid malpractice claims against U.S. physicians between 2004 and 2018. They found paid claims are not the result of bad luck or an inevitable part of practicing medicine, as many physicians think.1
The research makes clear malpractice claims are not random, says David Hyman, MD, JD, lead study author and a professor at Georgetown University in Evanston, IL. The paid claims reflect something about the physicians involved. “That might be objective quality of care issues,” Hyman says. “Or it might be communication strategies with patients, where the patients are more likely to seek out a plaintiff’s lawyer and sue when something untoward happens relative to physicians who have better communication strategies and interactions with their patients.”
One paid claim over a five-year period meant the physician was almost four times more likely to face at least one more paid claim in the next five years, compared to doctors with no prior paid claims, Hyman says. The likelihood increased with the number of paid claims.
“The magnitude of the increased risk is pretty striking. There have been prior studies that looked at one claim vs. two claims, but no one has ever looked at zero claims vs. one claim,” Hyman says. “There’s a tendency amongst physicians to say, ‘This whole thing is random, it’s all noise and there’s no signal here that you should rely on to guide intervention.’ Our findings suggest that there’s actually a pretty valuable signal embedded in just having one paid claim.”
The predictive power of a prior paid claim declines gradually as the time since the prior claim increases, meaning the chance of another paid claim decreases with each passing year.
A physician’s specialty had no bearing on the likelihood of a first paid claim predicting another. Publicity of a paid claim also had no effect. That means future lawsuits were unlikely to be prompted by a belief the specialty was risky or the physician was seen as vulnerable.
“There’s a tendency among physicians to say, ‘Oh, this is just piling on,’ that the plaintiff’s lawyers scout around for people who’ve had prior claims. It’s what we call a ‘blood in the water effect with the sharks forming,’” Hyman explains. “We find the same results whether there’s public disclosure of paid malpractice claims or not. That pretty clearly indicates that by and large, it’s not that after you have a first one, the next ones are because they’re targeting you.”
Hyman and colleagues suggest physicians with even a single paid claim could benefit from additional training and greater oversight.
“For risk managers, it means you should take seriously the signal that’s being conveyed by paid malpractice claims,” Hyman says. “You should use them as a basis for early interventions — noncoercive for people who are in a known high-risk specialty who only have one claim — and then a sort of graduated approach for people who have multiple prior claims, particularly in a low-risk specialty.”
Risk managers also should pay attention to patient complaints, Hyman suggests. There is no direct finding of a correlation in this study, but Hyman notes other research indicates complaints are an independent predictor of malpractice risk.
Patient Reviews Not Predictive
In another study, Hyman and a different group of colleagues assessed the relationship between online reviews by patients and the likelihood of a paid claim.2
“We identified the absolute worst doctors in two states, based on malpractice and disciplinary sanctions. They had multiple paid claims and sanctions by the disciplinary system,” Hyman says. “Then we compared them with matched physicians with completely clean records.”
Hyman and colleagues looked up all their online reviews and found there was not much difference in the patient reviews of both groups.
“Patients are not good at this assessment. They don’t have much insight into what the malpractice and discipline system think is a measure of good quality,” Hyman says. “It suggests that a doctor who says, ‘But I get great reviews,’ is not someone you should pay attention to, at least for that argument.”
- Hyman DA, Lerner J, Magid DJ, Black B. Association of past and future paid medical malpractice claims. JAMA Health Forum 2023;4:e225436.
- Hyman DA, Liu J, Black BS. Should patients use online reviews to pick their doctors and hospitals? J Empirical Legal Stud 2022;19:897-935.
- David Hyman, MD, JD, Professor, Georgetown University, Evanston, IL. Phone: (202) 661-6782. Email: [email protected].
Physicians with even one single paid malpractice claim are much more likely than those with no paid claims to experience more paid claims later, according to a recent study. Researchers examined all paid malpractice claims against U.S. physicians between 2004 and 2018. They found paid claims are not the result of bad luck or an inevitable part of practicing medicine, as many physicians think.
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