Medical malpractice experience of Taiwan: 2005 versus 1991

Background: Medical malpractice litigation has become an important issue worldwide. Although many epidemiological studies have been carried out, most studies were conducted cross-sectionally in developed countries and focused on malpractice litigation. We conducted nationwide surveys to investigate physicians' experiences associated with malpractice in 1991 and 2005, respectively.
Methods: By stratified systemic sampling, questionnaires were mailed to physicians in 1991 and 2005. Physicians were asked about the experience of medical malpractice and outcomes of malpractice. The outcomes of the malpractice were classified as resolution, settlement and lawsuit. We also collected physicians' demographic and professional characteristics.
Results: The prevalence of malpractice experience decreased from 44.1% in 1991 to 36.0% in 2005 ( P  = 0.004). The estimated annual malpractice claims decreased from 0.14 to 0.10 per physician in 1991 and 2005, respectively ( P  < 0.001). Physicians 45–64 years of age, obstetrician/gynaecologists and surgeons had significantly higher risk of malpractice. Compared with 1991, malpractice claims in 2005 were more likely to be brought into courts (23.1% in 2005 vs 15.7% in 1991, odds ratio (OR) = 1.48, P  = 0.020). In litigation cases, malpractice events in 2005 had more than triple the risk of 1991 to be sued in both civil and criminal courts (12.4% in 2005 vs 4.1% in 1991, OR = 3.31, P  < 0.001).
Conclusion: Compared with 1991, medical malpractice experiences were decreasing in prevalence, but increasing in severity in 2005. Additional studies, especially among different legal systems, are necessary to confirm these observations.     

Why do physicians vary so widely in their referral rates?

OBJECTIVE: To determine which physician practice and psychological factors contribute to observed variation in primary care physicians’ referral rates. DESIGN: Cross-sectional questionnaire-based survey and analysis of claims database. SETTING: A large managed care organization in the Rochester, NY, metropolitan area. PARTICIPANTS: Internists and family physicians. MEASUREMENTS AND MAIN RESULTS: Patient referral status (referred or not) was derived from the 1995 claims database of the managed care organization. The claims data were also used to generate a predicted risk of referral based on patient age, gender, and case mix. A physician survey completed by a sample of 182 of the physicians (66% of those eligible) included items on their practice and validated psychological scales on anxiety from uncertainty, risk aversiveness, fear of malpractice, satisfaction with practice, autonomous and controlled motivation for referrals and test ordering, and psychosocial beliefs. The relation between the risk of referral and the physician practice and psychological factors was examined using logistic regression. After adjustment for predicted risk of referral (case mix), patients were more likely to be referred if their physician was female, had more years in practice, was an internist, and used a narrower range of diagnoses (a higher Herfindahl index, also derived from the claims data). Of the psychological factors, only greater psychosocial orientation and malpractice fear was associated with greater likelihood of referral. When the physician practice factors were excluded from the analysis, risk aversion was positively associated with referral likelihood. CONCLUSIONS: Most of the explainable variation in referral likelihood was accounted for by patient and physician practice factors like case mix, physician gender, years in practice, speciality, and the Herfindahl index. Relatively little variation was explained by any of the examined physician psychological factors. This study was supported by a grant from the Agency for Policy Health Care and Research, R01 HS09397-01.     

Malpractice risk prevention for primary care physicians

The recent medical malpractice "crisis" has seen skyrocketing liability premiums and increasing fear of liability. Primary care physicians, especially family medicine and internal medicine physicians, have historically experienced low rates of malpractice claims, both in number and amount of payment. This can be attributed to several factors: the esteem held by internal medicine and family medicine physicians in their communities, relatively low numbers of invasive procedures, reluctance of patients to include "their" primary care physician in any potential litigation, and, probably most importantly, the atmosphere of mutual trust and communication between the internist or family physician and the patient. Recent years have seen this trend erased, as insurance industry data suggest primary care physicians presently face significant potential exposure for medical malpractice claims. It is imperative that primary care physicians take steps to insure they are adequately covered in case of a malpractice claim and that they practice aggressive but appropriate risk management to lessen the likelihood of a claim.     

The relation of patient satisfaction with complaints against physicians and malpractice lawsuits

PURPOSE: A small number of physicians generate a disproportionate share of complaints from patients and of malpractice lawsuits. If these grievances relate to patients' dissatisfaction with care, it might be possible to use commonly distributed patient satisfaction surveys to identify physicians at high risk of complaints from patients and of malpractice lawsuits. We sought to examine associations among patients' satisfaction survey ratings of physicians' performance and complaints from patients, risk management episodes, and rates of malpractice lawsuits. SUBJECTS AND METHODS: We examined 353 physicians at a large US teaching hospital whose inpatient performance was rated by 10 or more patients between January 1, 2001, and March 31, 2003. Physicians were divided into 3 tertiles according to satisfaction on a commercial survey instrument administered to recently discharged patients. Records of unsolicited complaints from patients (January 1, 2000, to March 31, 2003) and risk management episodes (January 1, 1983, to March 31, 2003) were analyzed after adjusting for the physician's specialty and panel characteristics of the physician's patients. RESULTS: Decreases in physicians' patient satisfaction survey scores from the highest to the lowest tertile were associated with increased rates of unsolicited complaints from patients (200 vs 243 vs 492 complaints per 100,000 patient discharges; P <0.0001) and risk management episodes (29 vs 43 vs 56 risk management episodes per 100,000 patient discharges; P = 0.007). Compared with physicians with the top satisfaction survey ratings, physicians in the middle tertile had malpractice lawsuit rates that were 26% higher (rate ratio [RR] = 1.26; 95% confidence interval [CI]: 0.72 to 2.18; P = 0.41), and physicians in the bottom tertile had malpractice lawsuit rates that were 110% higher (RR = 2.10; 95% CI: 1.13 to 3.90; P = 0.019). CONCLUSION: Patient satisfaction survey ratings of inpatient physicians' performance are associated with complaints from patients and with risk management episodes. Commonly distributed patient satisfaction surveys may be useful quality improvement tools, but identifying physicians at high risk of complaints from patients and of malpractice lawsuits remains challenging.     

Relationship between caseload volume and outcome for systemic lupus erythematosus treatment: the experience of Taiwan

OBJECTIVE: To determine if a physician's experience or hospital caseload volume is associated with in-hospital mortality of patients with systemic lupus erythematosus (SLE). METHODS: We used data from Taiwan's National Health Insurance Research Database covering 2002 to 2004. A total of 8536 hospital admissions citing a principal diagnosis of SLE were selected. Hospitals with an average of > 50, 26-50, and < 26 SLE cases per year were categorized as high, medium, and low-caseload-volume hospitals, respectively. Physician caseload volume was defined as low (< 1 SLE case per year), medium (1-3 cases per year), and high-volume (> 3 cases per year). Multivariate logistic regression analyses employing generalized estimated equations were performed to assess the independent association between physician or hospital SLE caseload volume and in-hospital mortality, after adjusting for other factors. RESULTS: We found that in-hospital mortality declined with increasing physician caseload volume (3.0%, 1.0%, and 0.8% for low, medium, and high-volume physicians, respectively), with the adjusted odds of in-hospital mortality for patients treated by low-volume physicians being 2.681 (p < 0.05) times greater than for patients treated by medium-volume physicians, and 3.195 (p < 0.001) times greater than for those treated by high-volume physicians. No significant relationship was found between in-hospital mortality and hospital SLE caseload volume (p = 0.896). CONCLUSION: We concluded that the factor of physicians' experience treating SLE is more crucial in determining in-hospital mortality than a hospital's annual SLE caseload.     

A survey of sued and nonsued physicians and suing patients

To systematically assess the impact of malpractice litigation on the doctor-patient relationship and to collect data that might suggest effective tort reform, we surveyed 642 sued physicians, nonsued physicians, and suing patients in Wisconsin. Parallel forms of survey instruments obtained information regarding changes in physicians' practices, changes in attitudes toward patients or physicians, and changes in physical and emotional well-being as a result of malpractice litigation or the threat of the same. In addition, opinions regarding causes and deterrents of malpractice litigation were obtained. Results suggested that claims or threats of malpractice suits had a negative impact on physicians' practices and emotional well-being; that this negative impact was more pronounced when the sued physician had been more personally involved with his patient prior to the malpractice claim; and that suing patients' and sued physicians' understanding of their relationship before the malpractice claim significantly differed. All respondents viewed improved physician-patient communication as the most effective method of preventing malpractice claims. Informal, alternative dispute resolution mechanisms in hospitals and clinics and improved peer review may decrease litigation and its deleterious effects.     

Fälle aus dem Grenzgebiet zwischen Geriatrie und Unfallchirurgie

Medical arbitration boards (“Schlichtungsstellen”, expert panels for extrajudicial malpractice claim resolution) try to settle claims of suspected malpractice between patients and their physicians and to avoid court trials. Numerous studies found an increasing incidence of adverse events with rising age. Injuries that occur in the hospital are frequently beyond the specialty of the treating physician. Therefore, the physician has to broaden his diagnostic view beyond the borders of his own specialty to recognize injuries in his patients and to prevent malpractice claims. In this paper, we report on adverse events in elderly patients where the geriatrician/internist was accused of negligence for not having promptly recognized a fracture after a fall or having chosen an inadequate operative procedure. For example, the importance of weight bearing osteosynthesis, mandatory in hip fractures in the elderly population to prevent long-term immobilization, is discussed. Adverse events due to negligence are more frequent among the elderly; the reasons are discussed. They will never be entirely preventable. The data presented in this report may be helpful to recognize fractures in time and to ensure adequate treatment, in order to reduce the number of court claims.     

Medical liability disputes involving thoracic and cardiovascular surgeons

BACKGROUND: Medical malpractice claims against surgeons are increasing. In Germany, as in most other European countries, there is no central registry of medical malpractice claims. It is not known at which rate medical liability claims are decided in favor of the physician or the patient. METHODS: All cases of reproaches of medical malpractice in which our clinic was involved within the 10-year period between 1989 to 1999 were reviewed. To compare our results with the general experience in the field of thoracic and cardiovascular surgery, we reviewed the data of the regional medical society in the same time period. RESULTS: From 1989 to 1999, our Clinic was involved in 74 medical liability disputes. There were 28 reproaches of medical malpractice against our department (0.1% of cases performed). Malpractice was detected in only 7 of 74 claims (9.5%). Most reproaches were made for incorrectly performed operations (80%), but only 4 (6.8%) of 59 claims were regarded as medical malpractice. CONCLUSIONS: Reliable data on reproaches of medical malpractice are virtually absent. Only 10% of all reproaches in our study were finally regarded as medical malpractice. A central registry of medical malpractice cases would allow analysis of the areas in which we have to improve performance, and how unjustified reproaches of medical malpractice can be avoided.     

Effect of physician and patient gender concordance on patient satisfaction and preventive care practices

OBJECTIVE: To explore the role of the gender of the patient and the gender of the physician in explaining differences in patient satisfaction and patient-reported primary care practice. DESIGN: Cross-sectional mailed survey [response rate of 71%]. SETTING: A large group-model Health Maintenance Organization (HMO) in northern California. PATIENTS/PARTICIPANTS: Random sample of HMO members aged 35 to 85 years with a primary care physician. The respondents (N=10,205) were divided into four dyads: female patients of female doctors; male patients of female doctors; female patients of male doctors; and male patients of male doctors. Patients were also stratified on the basis of whether they had chosen their physician or had been assigned. MEASUREMENTS AND MAIN RESULTS: Among patients who chose their physician, females who chose female doctors were the least satisfied of the four groups of patients for four of five measures of satisfaction. Male patients of female physicians were the most satisfied. Preventive care and health promotion practices were comparable for male and female physicians. Female patients were more likely to have chosen their physician than males, and were much more likely to have chosen female physicians. These differences were not seen among patients who had been assigned to their physicians and were not due to differences in any of the measured aspects of health values or beliefs. CONCLUSIONS: Our study revealed differences in patient satisfaction related to the gender of the patient and of the physician. While our study cannot determine the reasons for these differences, the results suggest that patients who choose their physician may have different expectations, and the difficulty of fulfilling these expectations may present particular challenges for female physicians. This research is supported by grant RO1-HS08269 from the Agency for Health Care Policy and Research. The authors wish to acknowledge the invaluable contributions of our project coordinator, Alison F. Truman, MS.     

Association between physician volume and in-hospital mortality in patients with systemic lupus erythematosus

OBJECTIVE: Systemic lupus erythematosus (SLE) is an uncommon, clinically complex disease for which prior experience treating similar patients may be particularly important. This study was undertaken to determine if physician volume is associated with the outcome of hospitalization of patients with SLE. METHODS: Data on in-hospital mortality in a population-based sample of 15,509 patients with SLE ages 18 years or older who were hospitalized in 2000, 2001, or 2002 in New York or Pennsylvania were obtained from state health planning agencies. Risks of in-hospital mortality were examined in relation to the average annual number of patients with SLE hospitalized by the admitting physician. RESULTS: Physician volume was inversely associated with mortality. Mortality was 4.1% among patients of physicians who treated <1 hospitalized patient with SLE per year, 3.5% among patients of physicians who treated 1-3 patients per year, and 2.5% among patients of physicians who treated >3 patients per year. After adjustment for demographic characteristics, severity of illness, and hospital characteristics, the mortality risk was 20% lower among patients in the middle category of physician volume (odds ratio 0.80, 95% confidence interval 0.66-0.96, P =0.02), and 42% lower among patients in the highest category of physician volume (odds ratio 0.58, 95% confidence interval 0.42-0.82, P = 0.002), compared with patients in the lowest category. The association was stronger among patients with nephritis (n = 2,673), for whom the adjusted odds of mortality were approximately 60% lower among those in the highest category of physician volume. CONCLUSION: Our findings indicate that higher disease-specific physician volume is associated with lower risks of in-hospital mortality in patients with SLE.     

Medical malpractice: a nonadversarial suggestion.

BACKGROUND: The current legal system for prosecuting medical malpractice claims has bred widespread discontent. It has increased costs, jeopardized the delivery of necessary medical services, and corroded the physician-patient relationship with mistrust and poor morale. METHODS: Analysis of fairness of compensation awards and deterrence of substandard medical services under the current system. RESULTS: Compensation awards are inconsistent and unfairly contingent on irrational, adventitious factors. The current system does not seem to have had a significant effect on detering poor medical practice or on improving medical practice in general. CONCLUSIONS: An alternative to the current litigation-oriented medical malpractice system should be established and centered around a four-member Medical Malpractice Tribunal composed of a general physician, an expert physician in the specialty area of the claim, an attorney, and a lay person. This tribunal would be empowered to investigate malpractice claims by gathering evidence and taking testimony from parties, experts, and witnesses. The tribunal could employ a table of treatment-related injuries in making findings as to physician liability and victim compensation. Such a system, through predictability, would likely increase malpractice prevention while decreasing legal costs and also costs associated with defensive medicine. Deterrence could be served by giving the tribunal power to recommend sanctions against substandard providers to appropriate licensing and disciplinary bodies and by requiring those found guilty of malpractice to contribute subsidies to a compensation fund.     

Physician advice to quit smoking

Objective: To estimate the percentage of California smokers who visit physicians each year and thus determine the extent of the opportunity for physicians to advise their smoking patients to quit; to identify sociodemographic and other characteristics related to smokers’ reporting that advice was given; and to look for evidence that physician advice influences quitting behavior. Setting and design: Data were collected as part of the 1990 California Tobacco Survey, a large (n=24,296) population-based telephone survey. Participants: 9,796 current smokers, including 5,559 daily smokers who had visited a physician in the preceding year. Measurements and main results: Two-thirds of all smokers had visited a physician in the year before the interview, but only about 5 0% of Hispanic and Asian smokers had done so. Multivariate analysis showed that advice at the last visit was independently related to older age, higher cigarette consumption, and poorer perceived health. Compared with smokers never advised to quit by a physician, those advised to quit at the last visit were 1.61 (95% confidence interval, 1.31–1 98) times more likely to report a quit attempt in the preceding year and 1.90 (95% confidence interval, 1.45–2.48) times more likely to be preparing to quit; however, those advised previously but not at the last visit showed no more quitting activity than did smokers never advised to quit. Conclusion: Physicians have considerable opportunity to reach all demographic subgroups of the population, but the nature of the subgroups advised most (those who are older, have high consumption of cigarettes, or have poor health) suggests that physicians tend to treat such advice as a therapeutic rather than a preventive intervention. Physician advice at the most recent visit encourages patients to think about quitting and probably leads to quit attempts. Thus, it is vital that physicians perform the simple intervention of advising every smoker to quit at every visit. Supported by Contract^#89-97872 from the California Department of Health Services, Tobacco Control Section, and Contract^#64182 from the County of Los Angeles Tobacco Control Section.     

Physician surveys to assess customary care in medical malpractice cases

OBJECTIVE: Physician experts hired and prepared by the litigants provide most information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, we examined the feasibility and potential value of surveying community physicians to assess standard of care. DESIGN: Seven physician surveys of mutually exclusive groups of randomly selected physicians. SETTING: Iowa. PARTICIPANTS: Community and academic primary care physicians and relevant specialists. INTERVENTIONS: Included in each survey was a case vignette of a primary care malpractice case and key quotes from medical experts on each side of the case. Surveyed physicians were asked whether the patient should have been referred to a specialist for additional evaluation. The 7 case vignettes included 3 closed medical malpractice cases, 3 modifications of these cases, and 1 active case. MEASUREMENTS AND MAIN RESULTS: Sixty-three percent of 350 community primary care physicians and 51% of 216 community specialists completed the questionnaire. For 3 closed cases, 47%, 78%, and 88% of primary care physician respondents reported that they would have made a different referral decision than the defendant. Referral percentages were minimally affected by modifying patient outcome but substantially changed by modifying patient presentation. Most physicians, even those whose referral decisions were unusual, assumed that other physicians would make similar referral decisions. For each case, at least 65% of the primary care physicians disagreed with the testimony of one of the expert witnesses. In the active case, the response rate was high (71%), and the respondents did not withhold criticism of the defendant doctor. CONCLUSIONS: Randomly selected peer physicians are willing to participate in surveys of medical malpractice cases. The surveys can be used to construct the distribution of physician self-reported practice relevant to a particular malpractice case. This distribution may provide more information about customary practice or standard of care than the opinion of a single physician expert.     

Effect of physician gender on the prescription of estrogen replacement therapy

OBJECTIVE: To determine if women cared for by female physicians are more likely to receive postmenopausal estrogen replacement therapy than women cared for by male physicians. DESIGN: Case-control study with follow-up telephone survey. SETTING: An outpatient practice at an urban teaching hospital in Boston, Massachusetts. PARTICIPANTS: Subjects were women begun on estrogen replacement therapy during an 18-month period; controls were matched on age and month of visit. Seventy-one cases (mean age 60 years, 41% nonwhite) and 142 controls (mean age 60 years, 48% nonwhite) were identified. Fifty-two (82%) of 64 eligible case patients and 89 (80%) of 111 eligible control patients completed a follow-up telephone interview assessing their preferences for female physicians and interest in estrogen replacement therapy. MAIN RESULTS: After adjusting for potential confounders using conditional logistic regression, patients with female physicians were more likely to begin estrogen replacement therapy than those seen by male physicians (odds ratio [OR] 5.4; 95% confidence interval [CIJ 1.8, 15.3). Case patients selected their primary care physician more often than control patients and were more interested in estrogen replacement therapy. After adjusting for potential confounders including patients’ preferences to select their physician and their interest in estrogen replacement therapy, patients with female physicians were still more likely to begin estrogen replacement therapy than those seen by male physicians (OR 11.4, 95% CI 1.1, 113.6). CONCLUSIONS: We conclude that female patients are more likely to be prescribed estrogen replacement therapy if they are cared for by female physicians rather than male physicians even after accounting for patient preferences. Further research is required to determine whether these differences reflect differences in physicians’ knowledge or attitudes regarding estrogen replacement therapy or reflect gender differences in how physicians discuss estrogen replacement therapy with their patients.     

Does physician gender affect satisfaction of men and women visiting the emergency department?

OBJECTIVE: To assess the association of physician gender with patient ratings of physician care. DESIGN: Interviewer-administered survey and follow-up interviews 1 week after emergency department (ED) visit. SETTING: Public hospital ED. PATIENTS/PARTICIPANTS: English- and Spanish-speaking adults presenting for care of nonemergent problems; of 852 patients interviewed in the ED who were eligible for follow-up, 727 (85%) completed a second interview. MEASUREMENTS AND MAIN RESULTS: We conducted separate ordered logistic regressions for women and men to determine the unique association of physician gender with patient ratings of 5 interpersonal aspects of care, their trust of the physician, and their overall ratings of the physician, controlling for patient age, health status, language and interpreter status, literacy level, and expected satisfaction. Female patients trusted female physicians more (P =.003) than male physicians and rated female physicians more positively on the amount of time spent (P =.01), on concern shown (P =.04), and overall (P =.03). Differences in ratings by female patients of male and female physicians in terms of friendliness (P =.13), respect shown (P =.74), and the extent to which the physician made them feel comfortable (P =.10) did not differ significantly. Male patients rated male and female physicians similarly on all dimensions of care (overall, P =.74; friendliness, P =.75; time spent, P =.30; concern shown, P =.62; making them feel comfortable, P =.75; respect shown, P =.13; trust, P =.92). CONCLUSIONS: Having a female physician was positively associated with women's satisfaction, but physician gender was not associated with men's satisfaction. Further studies are needed to identify reasons for physician gender differences in interpersonal care delivered to women. KEY WORDS: patient satisfaction; gender; physician-patient relations; delivery of care; health care quality.     

Why Do Patients of Female Physicians Have Higher Rates of Breast and Cervical Cancer Screening?

OBJECTIVE: Women are more likely to receive breast and cervical cancer screening if they see female physicians. We studied whether this is due to differences between male and female physicians, or to differences in their patients. SETTING: Large midwestern, independent practice association style of health plan. DESIGN: We surveyed male and female primary care physicians matched for age and specialty and a stratified random sample of three of each physician's women patients. Physicians reported on their practice setting, their attitudes and practices regarding prevention, and their comfort and skill with various examinations. Patients reported on their sociodemographic characteristics, their attitudes and practices regarding prevention, and their preferences for physician gender. Claims data were used to calculate mammography and Pap smear screening rates for the physicians PARTICIPANTS: We studied 154 female and 190 male internists and family physicians and 794 of their patients. MEASUREMENTS AND MAIN RESULTS: We compared the responses of male and female physicians and their patients and used multivariable analysis to identify the patient and physician factors that accounted for the differences in screening rates between male and female physicians. Female physicians were more likely to ask new patients about components of prevention, to believe in the effectiveness of mammography, to feel more personal responsibility for ensuring that their patients received screening, and to report more comfort in performing Pap smears and breast examinations. Patients of female physicians were more educated and less likely to be married, but did not differ in other sociodemographic characteristics. They had similar attitudes and practices regarding prevention, except that patients of male physicians were more likely to smoke. Significantly more patients of female physicians preferred a female for some component of care. In multivariable analyses, practice organization, patient preference for a female physician, and prevention orientation of female physicians accounted for up to 40% of screening rate differences between female and male physicians for Pap smears, and 33% for mammography. CONCLUSIONS: Differences in beliefs of male and female physicians and patient preference for a female provider contribute independently to the higher rate of breast and cervical cancer screening by female physicians.     

The ten-year malpractice experience of a large urban EMS system

Malpractice is a recognized and growing problem for physicians and hospitals, but it is difficult to ascertain the risk of malpractice in the prehospital arena. Dade County, Florida (greater Miami), with a population of 1.7 million, currently is served by 339 certified paramedics. During the decade of 1972 to 1982, Dade County Fire Rescue handled 265,060 incidents; 16 claims were filed with the Risk Management Division of Dade County. The claims were produced by 11 incidents, which yields a rate of one per 24,096 incidents. The two greatest problems identified were inadequate record keeping and "gray zone" patients who do not fit any particular protocol.     

Preventability of malpractice claims in emergency medicine: a closed claims study

We conducted a retrospective study of 262 malpractice claims against emergency physicians insured in Massachusetts by the state-mandated insurance carrier; these 262 claims were closed in the years 1980 through 1987. A total of $11,800,156 in indemnity and expenses was spent for these 262 claims. In 211 cases, the allegation was failure to diagnose a medical or surgical problem. One hundred eighty-four of these cases were included in the following eight diagnostic categories: chest pain, abdominal pain, wounds, fractures, pediatric fever/meningitis, aortic aneurysm, central nervous system bleeding, and epiglottitis. These eight categories accounted for 66.44% of the total dollars spent for the 262 claims. Because of the high incidence and dollar losses attached to these eight diagnostic categories, the Massachusetts Chapter of the American College of Emergency Physicians (MACEP) has developed clinical guidelines for the evaluation of these high-risk areas. Of the 184 high-risk claims, 99 claim files were reviewed; 45 of these reviewed claims were judged by physician reviewers as preventable by the application of the MACEP high risk clinical guidelines. From 22.26% to 46.4% of the $11,800,156 spent on the 262 claims could have been saved by the application of the MACEP clinical guidelines.     

Portrayal of female physicians in cardiovascular advertisements

BACKGROUND: Despite increasing numbers of female medical school graduates, few women enter cardiovascular specialties. Pharmaceutical promotion may influence physician behaviour. It is unclear how female physicians are represented in cardiovascular advertisements, which may, in turn, influence physician perceptions. OBJECTIVES: To determine if female and male physicians are equally represented in cardiovascular advertisements. METHODS: All cardiovascular advertisements from American editions of general medical and cardiovascular journals published between January 1, 1996, and June 30, 1998, were examined. For each unique advertisement, the total number of journal appearances and the number of appearances in journals' premium positions were recorded. The role, sex, age and race of the primary figure featured in the advertisement were noted. RESULTS: Nine hundred nineteen unique advertisements were identified, 35 of which depicted a physician as the primary figure. Six (17%, 95% CI 8.1% to 32.7%) of these advertisements portrayed a female physician, while 29 (83%, 95% CI 67.3% to 91.9%) depicted a male physician (P<0.001). Female physician advertisements appeared in journals 39 times (20.7%; 95% CI 2.8% to 43.5%), while male physician advertisements appeared 149 times (79.3%; 95% CI 56.5% to 97.2%) (P=0.01). The odds ratio for a female physician advertisement appearing in a premium position compared with a male physician advertisement was 0.25 (95% CI 0.09 to 0.68). CONCLUSION: The relative paucity of female physicians in cardiovascular advertisements is a concern because it may both reflect and reinforce sex asymmetries in cardiovascular specialties.