Internists and family medicine providers, who represent 25% of physicians actively providing patient care in the US, are typically on the front lines of diagnosing and treating health conditions. With this essential role comes significant medical professional liability (MPL) risk.
Given provider shortages and limited resources in healthcare systems, identifying and addressing top malpractice risk areas is critical. MPL data can help providers and systems focus on the most vulnerable areas to prioritize improvement efforts and reduce risk.
Top Allegations in Medical Malpractice Claims Against General Medicine Clinicians
Candello’s national database, which tracks more than 440,000 open and closed MPL cases, was leveraged to uncover insights into claims involving general medicine services—defined in this analysis as general internal medicine and family medicine services. General internal medicine comprises general care for adults, including primary care. By contrast, family medicine includes general care physicians who also provide care to children. Of 71,672 cases closed between 2014 and 2023, 6,544 (9%) were tied to general medicine services, as seen in the Figure below. The top allegations in these cases involved issues with diagnosis, medical treatment, and medication management, each presenting liability risk.
Diagnostic failures
Diagnosis-related errors, such as missed or delayed diagnosis, consistently rank among the top causes of MPL claims across all specialties. However, family and general internal medicine providers are particularly impacted, with this service area accounting for 20% of all diagnosis-related claims or lawsuits between 2014-2023. The severity of clinical outcomes in these cases is considerable, with 73% of these cases involving a patient who experienced high-severity injuries, which encompasses major permanent injury and death.
Such devastating outcomes not only have profound personal and emotional consequences but also carry significant financial weight. Diagnosis-related cases within general medicine alone resulted in a staggering $1 billion in gross losses, with nearly half of these cases closing with an indemnity payment.
Primary contributing factors include delays in ordering tests, missed or unrecognized symptoms, and failure to order timely consults or referrals. Neoplasms were the most cited diagnosis, accounting for 37% of the claims, followed by cardiovascular diseases (23%), and bacterial infections (4%).
Medical Treatment Issues
While less frequent than diagnosis-related errors, inadequate or incorrect treatment remains a significant risk, with common contributing factors including the failure to recognize and reconcile symptoms, delay in obtaining consults, and problems with the selection and management of therapy. Notably, cases involving the treatment of circulatory system diseases were some of the most common (17%), and 87% of these cited a high-severity clinical injury or death.
Medication Errors
Medication errors, though resulting in fewer indemnity payments than diagnostic and treatment errors, remain a critical risk in general medicine, associated with a gross total of $197 million in losses. Approximately 50% of these claims involved high-severity outcomes, underscoring the need for robust interventions. Contributing factors often include improper medication selection, insufficient monitoring, and inadequate patient education about medication risks.
Risk Mitigation Strategies
MPL insurers can work with their customers or members to incentivize interventions and programs to mitigate key risk areas highlighted in the data. Below are several effective strategies that can help address some of the identified risks.
- Ambulatory Safety Nets: These systems are designed to close the communication loop and ensure abnormal findings receive the necessary follow-up. These safety nets have proven effective, showing improved follow-up rates on abnormal test results. In practice, safety net programs such as those within the Kaiser Permanente Southern California and Harvard Medical communities have helped reduce the risk of missed diagnostic opportunities by creating structured, collaborative communication channels between patients and providers.
- Clinical Decision Support (CDS) Systems Tools: Estimated to be integrated into electronic health record (EHR) systems of 90% of hospitals and 80% of clinics, CDS tools are designed to provide timely, evidence-based information to clinicians and patients at the point of care. These decision support systems can offer many features, such as provider and patient reminders, customized treatment recommendations based on a patient’s symptoms, and medication reconciliation. While these tools are not without risk, research has demonstrated that CDS implementation can reduce treatment errors, particularly in complex chronic disease cases, by prompting clinicians to consider best practices and alternative diagnoses as patient data evolves. This type of support is invaluable in busy primary care settings, where providers must balance time efficiency with thorough decision-making. By flagging potential red flags, such as contraindications or drug interactions, CDS tools reduce the cognitive load on clinicians and support safer, more informed treatment decisions—an essential element in mitigating claims.
- Pharmacy-led Medication Rounding: While CDS tools can help flag potential drug interactions and discrepancies, having pharmacy staff involved at transitional points of care is another effective strategy in helping to mitigate medication errors. A systematic review in the Journal of Clinical Pharmacy and Therapeutics found that pharmacist-led medication reconciliation can significantly decrease adverse drug events and discrepancies during admissions and discharges.
Leverage MPL Data
In an increasingly complex healthcare environment, leveraging MPL data to identify risk patterns is critical for designing proactive, targeted interventions. Large MPL databases, such as Candello’s, offer valuable insights into specific vulnerabilities across various clinical disciplines. By examining detailed trends—such as common contributing factors and major allegations—precise risk-reduction strategies can be designed and implemented to best protect providers and advance patient safety.
Additionally, routine data review can help insurers, healthcare institutions, and providers recognize emerging risks as patient care practices evolve. For example, shifts in prescribing trends or the introduction of novel treatments may create new liability exposures. Continuous data monitoring enables insurers to adjust recommendations and resources proactively, adapting to these shifts before they translate into claims.
By adopting a data-informed approach, insurers can play a pivotal role in fostering a safer healthcare environment. Through targeted support and collaboration, they not only help reduce the frequency and severity of malpractice claims but also contribute to the broader goal of improving patient care quality. In this way, claims data serve as both a retrospective analysis tool and a proactive resource for guiding sustainable improvements in mitigating medical professional liability risk.