SUMMARY: Characteristics of physicians who are more likely to provide substandard care are well-researched. Much individual physician vulnerability to making negligent errors could have been detected and avoided. Prevention is still in its infancy. Medical malpractice litigators can usefully uncover deficiencies in anticipating negligent error.
The concept of "bad apples" is part of a culture of "name-blame-shame" that needs to be abandoned in our striving toward greater patient safety. For various reasons, about 1 in 6 physicians will be impaired at some stage in their professional careers. 1
Nevertheless, a minority of physicians are at significantly greater risk of being sued, sometimes repeatedly, for medical malpractice.
Characteristics of physicians who are more likely to provide substandard care are well-researched.
Problem physicians may be persistently disabled by fatigue or mental or physical impairment 1a, or may fail to maintain or acquire further knowledge and skills.
Psychiatric problems that are common among physicians include burn-out 2, depression, and substance abuse. Age-related and disease-related cognitive impairment may be particularly insidious in onset.
It is likely that all clinicians provide substandard care at times as a result of fatigue. Nevertheless, some physicians, because of their personalities, lifestyles, specialties or manpower shortages, are frequently impaired by sleep deprivation. 3
As we have noted previously, burnout is common among physicians. 4 []
Depression is no less common in the medical community than in society in general 5, and completed suicide is more prevalent, particularly among female physicians. 6
Since the prevalence of drug and alcohol abuse in physicians is known to be high, it is evident that the majority is undetected, and it may be a material factor in the provision of substandard medical care.
Much individual physician vulnerability to making negligent errors could have been detected and avoided.
Particularly in under-doctored communities, professional licensing authorities may face difficulty in striking a balance between safe training standards 7 [] and provision of adequate medical manpower. 8
Hospital credentialing is often more flawed than consumers and litigation counsel might imagine. []
There is a paucity of criteria on which to assess the adequacy of the training and experience of newly appointed surgeons and physicians in specific operative and investigational procedures.10
Hospital Boards often play a perfunctory role in ongoing credentialing [], dependent as they necessarily are on the advice of the medical community in general, and heads of specialist clinical departments in particular. Arguably, Hospital Boards have a responsibility, independent of that of individual surgeons, to refuse to sanction surgical procedures that have been shown to be more safely provided by operators and hospitals with greater annual volume.
Fellow physicians are sometimes alarmingly unaware of a colleague's increasing incompetence and, even when they are so aware, personal loyalties and manpower needs may deter them from alerting other colleagues and hospital authorities to a developing problem.
Practical PointerMuch more is known than is practically applied |
Prevention is still in its infancy.
Most licensing authorities now require annual evidence of adherence to a minimum schedule of annual Continuing Medical Education activities. 11
Some licensing boards and colleges are moving, at various speeds, towards regular review of the performance 12 and continuing competence. 13
A smaller number are trying to develop programmes for regular re-evaluation of professional knowledge and skills.
Hospitals commonly miss a wealth of learning opportunities to prevent future physician failure. 14
Practical PointerHospitals and clinics may have failed to anticipate and prevent negligent error |
Medical malpractice litigators can usefully uncover deficiencies in anticipating negligent error.
In developing a more systemic approach to medical malpractice litigation, counsel should routinely seek evidence of avoidable factors of which the Defendant physician's colleagues and credentialing hospital could and may have been aware.
Practical PointerRoutinely explore common Defendant vulnerabilities in medical negligence Discoveries:
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