In a recently published Medscape Psychiatrist Malpractice Report 2019, it was revealed that 41% of psychiatrists in the United States have faced at least one malpractice lawsuit. This comprehensive survey, conducted among 4360 physician members across more than 25 specialties, sheds light on the reasons behind these legal actions and their impact on the practice of psychiatry.
The primary cause cited for malpractice lawsuits among psychiatrists was wrongful death, accounting for 31% of cases. Other significant reasons included poor outcome or disease progression (23%), failure to treat or delayed treatment (11%), errors in medication administration (10%), and complications from treatment or surgery (8%). Interestingly, failure to diagnose or delayed diagnosis, which topped the list for physicians overall in the Medscape Malpractice Report 2019, constituted only 7% of lawsuits against psychiatrists.
Surprisingly, 87% of psychiatrists believed that the lawsuits against them were not warranted, with only 2% considering legal action justified – the lowest percentage among all physicians surveyed. When faced with litigation, 44% of psychiatrists expressed being very surprised, while 41% were somewhat surprised, and 15% were not surprised at all.
Delving into the psychological factors contributing to malpractice claims, David S. Szabo, a malpractice defense attorney, highlighted issues arising from perceived breakdowns in the doctor-patient relationship or patients feeling shut out of productive conversations with their healthcare providers.
The survey unveiled the considerable time investment required for legal defense, with 43% of psychiatrists spending over 40 hours on their cases. The process itself, from gathering records to deposition preparation, took 1 to 2 years for 46% of respondents, while 23% reported it dragging on for 3 to 5 years.
Regarding the resolution of malpractice cases, one-third of psychiatrists settled out of court, and of those that went to trial, only 12% reported a verdict in their favor. Interestingly, 61% of psychiatrists believed that most malpractice lawsuits stem from patients misunderstanding medical risks and blaming doctors for adverse outcomes, rather than constant lawyer advertising seeking new clients.
A noteworthy finding was that 93% of psychiatrists surveyed carried malpractice insurance, a figure in line with the overall physician population (94%). In cases where settlement or trial was necessary, about half of these decisions were influenced by insurers.
Despite the potentially devastating impact of lawsuits on physicians, 48% of psychiatrists reported making no changes to their practice after resolution. However, 27% acknowledged a shift in their approach to patients, and 8% made significant changes such as leaving their practice setting or obtaining additional malpractice insurance.
In terms of financial outcomes, nearly half of the monetary awards for settled or plaintiff-favored cases capped at $100,000, with 31% reaching $500,000 and 8% reaching $1 million. Reflecting on the fairness of outcomes, 55% of psychiatrists named in a lawsuit believed the result was fair.
Psychiatrists admitted that, in hindsight, they would have approached certain situations differently to avoid legal action. Suggestions included maintaining better documentation (20%), being more selective in accepting patients (15%), spending more time with patients and families (11%), seeking second opinions from colleagues (9%), and reviewing patient history and charts more carefully (7%).
Interestingly, the majority of psychiatrists (75%) felt that offering apologies or expressing regret would not have prevented the lawsuit. This contrasted with the broader physician community, where 82% believed that apologies would not have made a difference.
Psychiatrists proposed that improving patient communication and rapport (59%) and implementing medical panels to screen cases for merit (50%) are effective strategies to deter lawsuits. However, both psychiatrists (51%) and physicians in general (56%) expressed dissatisfaction with the perceived lack of effort by medical organizations or state societies in discouraging malpractice cases.
This comprehensive report provides valuable insights into the challenges faced by psychiatrists dealing with malpractice lawsuits, highlighting the need for malpractice insurance for psychiatrists, along with improved communication, careful case selection, and proactive measures to mitigate legal risks in the field of psychiatry.
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