Although most malpractice cases against dermatologists are abandoned, withdrawn or dismissed, communication with patients may minimize liability, especially for dyschromia, which is the most prevalent outcome resulting in claims, according to a study in JAMA Dermatology.
The study, which was published on Dec. 6, found that male dermatologists were sued more often than female dermatologists. Why? Female physicians are better communicators.
“A meta-analysis on sex differences in medical communication found that female physicians are more likely to actively engage in patient-centered communication. That is, female physicians more often elicit and validate patient input and provide encouragement and reassurance,” according the study authors April W. Armstrong, M.D, and colleagues.
Male physicians were found to be 2.5 times more likely to be sued for medical malpractice than their female counterparts.
Female physicians are more inclined to actively engage in patient-centered communication. “All physicians can practice and improve patient-centered communication, which may help enhance patient satisfaction and outcomes,” the authors wrote.
Researchers analyzed 90,743 closed claims: 1,084 against dermatologists; 89,659 against other specialty physicians. Nearly 70 percent of lawsuits were brought against male physicians compared to 25 percent of female physicians.
Physicians in solo practice were more likely to be sued (55.4 percent of all cases) compared to 37 percent of physicians in group practices and 3 percent of physicians who work for large medical institutions. Most claims at 68 percent were abandoned, withdrawn or dismissed. Between 2006 and 2015 most trial verdicts favored defendants by a factor of seven. Most claims were as a result of medical errors from skin operations, followed by misdiagnoses.
Between 1991-1995 and 2011-2015, there was a reduction of 29 percent in paid claims for dermatologists and physicians of all specialties. But to attribute this downward trend to tort reforms is slightly premature because associating declines to paid claims has been difficult to concretely ascertain.
Patient safety practices in dermatology also appear not to be the reason for the decline.
As for the role of disclosure and apology programs for the decease, a study from Vanderbilt University concluded that these programs do not impact the number of claims, although they may lead to quicker resolution.
Further, a Medscape survey of primary care physicians found that 81 percent felt that saying “I’m sorry” would not have helped and only 3 percemt were sure that it would be of benefit. In addition, these findings held true for both male and female physicians.
For dermatologists, in particular, there has been only a 2.5 percent reduction of closed claims over the past 20 years, compared to a 17.9 percent reduction for all specialties.
The mean recovery per claim overall was $238,000, which is twice that of $118,000 for the time period between 1991 and 2005.
“This is concerning for physicians and for all those interested in improving patient care because it could indicate that dermatologists are slipping behind, while other specialties are improving,” according to Sailesh Konda, M.D., and Abel Torres, M.D., J.D., in an editorial that accompanied the study.
The two most frequent reasons for claims in dermatology are errors that occur during an operative or diagnostic skin procedure and misdiagnosis, respectively.
Identifying specific errors would help improve dermatologic practice patterns; for example, are wrong-site surgeries at fault or inadequate informed consent?
The jury is out, however, as to the impact that physician extenders have on the number of claims. One study found that extenders were less likely to be sued than physicians themselves, but other studies have shown increased liability for physician extenders that employ lasers.
Continuing education on traditional and novel techniques of biopsy site identification could alleviate these concerns, as could skin biopsy photos taken before and after the procedure.
Dermatologists practicing at institutions as opposed to other settings have fewer closed claims. But this finding may be deceptive, as “the institution may proceed with a negotiated settlement that results in a paid claim but not a closed claim for the dermatologist, who might have been dropped from the claim,” the editorial authors wrote.
Heather Kornmehl, BS; Sanminder Singh, BS, BA; Brandon L. Adler, MD; et al. "Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015," JAMA Dermatology, Published online Dec. 6, 2017. DOI:10.1001/jamadermatol.2017.3713
Sailesh Konda, MD; Abel Torres, MD, JD. "Practicing Safe Dermatology—Screening Out Liability," JAMA Dermatology, Published online Dec. 6, 2017, Editorial. DOI:10.1001/jamadermatol.2017.4838