Letter to the Editor: The Real Numbers of Malpractice Risk

doi: 10.1097/01.EEM.0000515705.59333.22
Letter to the Editor

Editor:

Carlo Reyes, MD, JD, and Rebecca Reyes, MD, JD, discussed malpractice-related stress in the February issue. (“Medical Malpractice Stress Syndrome Takes Its Toll,” EMN 2017;39[2]:19; http://bit.ly/2kkZ4WG.) As my institution's hospital risk officer and a former med-mal defendant, I am very familiar with this phenomenon. Surveys commonly identify fear of litigation as a contributor to job dissatisfaction and burnout among physicians. I have no doubt about the truth of such findings.

It is also my opinion that some of our collective angst is based upon misinformation and misunderstanding about our risk of facing litigation and its downstream impact on our careers and personal lives. I have found in speaking with colleagues that simply laying out the facts can significantly alleviate the worst of our fears. I do not wish to minimize the risk, but I also think we need to guard against the tendency to exaggerate our anxieties.

So I was surprised to see the following statement from the New England Journal of Medicine in Drs. Reyes' article: “Ninety-nine percent of physicians in high-risk specialties such as emergency medicine will be sued by age 65. (N Engl J Med 2011;365[7]:629.)”

Such a statement paints the worst possible picture. It virtually guarantees that almost all of us will be named in a suit. And it is wrong. Happily, the truth is a little different.

The statement described the risk of malpractice lawsuit by specialty. It did, indeed, state that the lifetime risk for high-risk specialties is 99 percent. But emergency medicine was not one of the five high-risk specialties identified. Those were neurosurgery, thoracic-cardiovascular surgery, general surgery, orthopedic surgery, and plastic surgery.

Neither is EM a low-risk specialty. Our specialty is almost at exactly the mean of all specialties in terms of annual claims. The authors did not quantify career risk for EM, but the next closest specialty to ours was internal medicine, with a cumulative risk of 89 percent. Keep in mind that this is simply the risk of facing a lawsuit. The risk of the first indemnity payment is lower for high-risk specialties at just 33 percent and five percent for low-risk specialties. The mean and median payments rank EM in the bottom third of specialties.

All those numbers seem too high, of course. Most of us will be named in a suit at least once. But it isn't a 99 percent certainty, and our risk compares quite well with many of our colleagues. I hope that this more accurate description of the risk situation will help prevent unnecessary stress.

Howard Blumstein, MD

Winston-Salem, NC

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