OMISSION-RELATED MALPRACTICE CLAIMS AND THE LIMITS OF DEFENSIVE MEDICINE

To describe the malpractice environment as it relates to defensive med icine, the authors studied omission-related claims from a large physic ian-owned malpractice insurer covering 70 percent of physicians in a n ortheastern state. During a 12-year period (1977-1989), claims resulti ng from alleged diagnostic omissions were considered important in less than 9 percent of claims and of central importance in 4 percent. Comp ared with other claim types, omission-related claims were more likely to be paid, had a higher median payment, and were more often associate d with significant patient injury or death; the association with more frequent payments remained after controlling for physician specialty, geographic region, and degree of patient injury. Malpractice claims al leging diagnostic and monitoring omissions are relatively uncommon but appear difficult to defend relative 50 other claim types. Taken in li ght off he changing health care environment, these results highlight t he limits of defensive medicine and support an expanded focus for medi cal liability reform.