Self-Assessment of Medico-Legal Risk by Doctors: The Know Your Risk Version I - Short Form

Article excerpt

Abstract

An instrument to measure medico-legal risk-management behaviours among medical practitioners was developed and tested. A cross-sectional survey was posted to 962 UNITED Medical Protection members receiving premium support. A final sample of 757 currently working medical practitioners responded, including general practitioners (21.9%), surgeons (29.9%), obstetricians and gynaecologists (12.7%), and others (35.5%).

The Know Your Risk Version 1 - Short Form and other tools developed by this team are available for use by group practices, hospital administrators and practitioners. These tools have the potential to assist regulators and insurers to identify, monitor or screen individual medico-legal risk behaviours.

Aust Health Rev 2008: 32(2): 339-348

THE MEDICAL INDEMNITY CRISIS sweeping the Western world has had a major impact on Australian doctors and their insurers. A sharp increase (38%) in claims occurred in the early 2000s (50 claims per 1000 doctors in 1995-1996 compared with 69 per 1000 doctors in 2002-2003)1 with some slowing within the past few years. Considerable tort reform (commencing in New South Wales with the Health Care Liability Act 2001) and government intervention to transform the medical indemnity industry (Medical Indemnity Act 2002 [Cwlth] and amendments to 2005) has resulted in some positive outcomes for medical practitioners with some premium reductions and premium subsidies. There has also been significant improvement in the capital base of insurers, with consequent increased stability and security in medical indemnity insurance supply. With the advent of the Premium Support Subsidy there was a requirement from the Health Insurance Commission for insurers to guarantee that doctors eligible for the subsidy participate in risk-management programs considered by the insurer to be appropriate. These programs are designed to assist doctors to identify risks and implement appropriate risk mitigation strategies.2 As Wilson and Fulton logically argue " . . . if the right risk management processes and systems are in place, hospitals and doctors should be able to rebut allegations of negligence in 80% of cases . . ." (p. 77).3

In response to this need, UNITED Medical Protection (UNITED), commissioned a study to develop and test a self-assessment instrument to assess risk-management behaviour among doctors requesting premium support. It was envisaged that a self-monitoring tool would be a simple approach for doctors to comply with the regulations under the support scheme. Medicolegal risk-management behaviour is defined in this study as those systems, processes or behaviours that have been found to either reduce the likelihood of a claim or enhance the defensibility of medical practitioners.

Risk-management behaviour across specialities

Risk varies across medical specialties: obstetrics have infrequent but high-cost claims,4'3 while surgery has the potential for 15% of procedures to result in permanent disability or death.6 When injury occurs and care is required it is more likely that a claim will ensue.7 A review of research studies focusing on claims, incidents and adverse events, conducted within the major specialties such as general practice, surgery, and obstetrics and gynaecology, was undertaken before developing items for the Know Your Risk (KYR) instrument.

According to Britt et al, self-reported general practice incidents were related to pharmacological treatments (52%); non-pharmacological treatments (37%); diagnostic (28%); and equipment (5%) issues.8 The factors implicated in these incidents included poor communication and difficulties with identifying signs and symptoms and transferring or processing information.8,9

An Australian study by Andrews and Barrett10 which included a review of legal precedents11 of failure to diagnose emphasised "poor communications between doctors and patients, delays in following up test results, failure to order the relevant diagnostic interventions and patients failing to attend appointments", (p. …