Data reveals malpractice patterns

National report - While dermatology ranks lower than many other specialties in terms of malpractice claims made and paid, collecting and analyzing data in these areas can help dermatologists minimize their risk even more, experts say.

Overall, "We need more information about the current malpractice situation," says Sandra I. Read, M.D., a Washington-based dermatologist in private practice who sits on the claims and underwriting committee of ProAssurance, the nation's fourth-largest medical liability insurer (according to http://www.proassurance.com/).

"Accurate information will allow us to better risk-manage our practices," she tells Dermatology Times.

In this climate, Dr. Hill explains, some physicians "biopsy everything, regardless of how benign it looks, out of fear that a patient will make a claim later that the lesion or another one nearby turned out to be malignant."

At the other extreme, he says, "Malpractice claims are so threatening professionally and personally" that some physicians avoid dealing with the topic altogether. "People don't want to talk about it," Dr. Hill says, "but I believe there are doctors who prefer to remain in denial," to the extent that some "go bare," carrying no malpractice insurance at all.

To fill the information gap, Drs. Hill and Read say they analyze available literature from legal sources and the Physician Insurers Association of America (PIAA). They've also begun collecting additional information that they say will help them describe malpractice trends in terms of clinical contexts that will be meaningful to practicing physicians; namely, the clinical situations, procedures and diagnoses which bear increased risk for dermatology claims, and how dermatologists compare to other specialists.

Insurers consider numerous factors

"Malpractice is not perfectly defined within the law, but it's understood to be a violation of the standard of care which results in harm to an individual" and is sometimes referred to as negligence, Dr. Hill says.

In contrast, he says, "A claim is an argument or demand that's brought by a patient or patient's representative" stating the patient is entitled to money and why. The two concepts don't necessarily overlap because some claims are found to be frivolous while others aren't, Dr. Hill adds.

However, he says, "The other thing we've discovered in the course of this work over the last couple years is that insurance companies have begun assessing their insured physicians based not just on whether or not they've lost lawsuits" or cost the company money in judgments or settlements, but also on whether a doctor has cost the company money in defending or investigating a suit, claim or patient complaint.

"Even if the doctor is subsequently found not to have been negligent and the patient doesn't win any money," Dr. Hill explains, "it still costs the insurance company."

Therefore, Dr. Read says that in insurers' eyes, "No longer is it enough to be simply a claims-free doctor - one also must be a cost-free doctor to keep one's malpractice rates down. The climate is becoming much tighter for doctors."

Dermatology claims low, but diverse

Fortunately for dermatologists, their specialty ranks 19th of 28 studied in terms of claims made between 1985 and 2001, Drs. Hill and Read say.