Medico-legal risk: What physicians working in primary care need to know

The Canadian Medical Protective Association (CMPA) represents over 105,000 physicians and draws experience from its database of over 500,000 medico-legal cases. These cases include civil legal actions, regulatory authority (Colleges), and hospital matters.

As of the end of 2021, 37,083 CMPA members were family medicine physicians (Type of Work 35, 73, 78 and 79). In addition to primary care, some of these physicians (Type of Work 73, 78 and 79) provide specialized care including surgery, anesthesia, obstetrics, and shifts in the emergency department.

Between 2016 and 2020, the CMPA closed 6,175 medico-legal cases involving family physicians providing primary care, i.e. non-specialized services. This report describes findings based on these medico-legal cases (civil legal actions, College
complaints, and hospital matters).

What are the most common patient complaints? (n=6,175)¹

Complaints are a reflection of the patient’s perception that a problem occurred during care. These complaints are not always supported by peer expert opinion. Peer experts² may not be critical of the care provided, or may have criticisms that are not part of the patient complaint.

Diagnostic error is a major issue for primary care physicians. The remaining sections of this report focus on the 1,260 cases in which diagnostic error was identified by the peer experts.

What are the most frequent misdiagnoses? (n=1,260)

What are the top factors associated with severe patient harm? (n=1,260)⁴

Risk reduction reminders

The following risk management considerations have been identified for reducing diagnostic errors in primary care:

• Review all key elements of the patient’s medical record including earlier entries and referral notes. Pay attention to abnormal vital signs or physical findings.
• Actively consider what information supports the favoured diagnosis and what information does not fit, and thus minimize cognitive biases.
• Optimize office procedures for
  • flagging abnormal results;
  • generating a communication task to inform the patient of results;
  • outlining the timeframe to communicate with patients who require urgent follow-up; and
  • confirming that patients have received messages and booked appropriate follow-up.
• Take a structured approach (e.g. SBAR, I-PASS) to communicating key information from the patient profile (e.g. medications, allergies, and patient wishes including advance directives and special exemptions) at patient handover and at every transition of patient care. Ensure important information is flagged during patient handover.
• Clearly define the roles and responsibilities of each team member to optimize care.

Now that you know your risk…

Mitigate your medico-legal risk with CMPA Learning resources.

• CMPA workshop: Advanced Diagnostic Reasoning
  
• eLearning activity: Informed consent
  
• eLearning activity: Disclosing harm from healthcare delivery
• "Physician-Patient: Patient-centred communication", CMPA Good practices

Questions?

Please contact [email protected]

Notes

1. 1. 
   There may be more than one complaint per case.
2. 2. 
   Peer experts refer to physicians who interpret and provide their opinion on clinical, scientific, or technical issues surrounding the care provided. They are typically of similar training and experience as the physicians whose care they are reviewing.
3. 3. 
   This includes lumbar and other intervertebral disc disorders with radiculopathy; spinal stenosis of the cervical and lumbar regions; and intervertebral disc displacement or degeneration.
4. 4. 
   Severe patient harm refers to harm that results in patient death or severe outcome.
5. 5. 
   Based on peer expert opinions.