A recent survey of AAP members shows that many of them take measures designed specifically to reduce the risk of medical liability lawsuits.

The Periodic Survey of Fellows is a self-administered questionnaire conducted by the AAP Department of Research. The survey provides a means of systematically gathering data on various issues of importance to AAP officials. Findings from the Periodic Survey are used to inform AAP leaders as they consider creating, modifying or eliminating programs and policies.

The Survey, “Medical Liability Experiences and Office Management: Periodic Survey #17,” was mailed to a random sample of 1,600 U.S. AAP Fellows. Fellows selected to participate in the survey will not be selected again for at least four years. The response rate was 81 percent.

The survey examined pediatricians’ experiences with medical liability claims and suits, and selected risk management issues in pediatric practices. Both topics were initiated by the AAP Committee on Medical Liability. The office management questions were fielded to support the AAP Ambulatory Care Self Assessment Project, and to help focus the liability committee’s risk management activities. (See accompanying article.)

Findings from the survey revealed that the percentage of pediatricians reporting a claim or suit for malpractice, including claims that occurred during residency, remained about the same in 1992 as in previous surveys conducted in 1990 and 1987 (30.4 percent, 29.3 percent and 26.9 percent, respectively).

The survey also queried pediatricians about their office practices related to areas of risk management.

More than two-thirds of pediatricians in direct patient care (69.3 percent) indicated that their practice has informal training in telephone management and nearly half (48.3 percent) said they have a written protocol for ensuring that pertinent information from telephone calls is put into medical records.

Respondents were fairly evenly divided between those whose practices keep a log of all its telephone contacts (44.1 percent) and those who keep a log of only some telephone contacts (41.3 percent). The overwhelming majority of these practices said they include the patient’s problem in the log (95.7 percent) along with instructions or information given in the call (85.8 percent).

Forty percent of pediatricians in direct patient care said they record drug allergies in a specific place within the patients chart and 27.3 percent said drug allergies are noted on the cover of a patient’s chart. Twenty-three percent said they record drug allergies in both these places.

About two-thirds of the respondents in direct patient care said they routinely document review of laboratory reports (70.9 percent), X-ray report (68.1 percent), consultant reports (67.3 percent), and hospital discharge summaries (64.1 percent) before placing them in the patient’s chart. More than half of pediatricians (58.5 percent) who do preventive care document negative findings in their patients’ medical records after routine preventive care exams.

Among pediatricians who have had a claim or a suit for malpractice filed against them, one-half (50.3 percent) said that they have not changed any office management practices as a result of the experience of being sued. However, about one-fourth of these pediatricians said that as a result of a malpractice suit they have increased the number of consultants or lab tests (25.5 percent), and they document telephone calls (23.8 percent) and negative findings in the patient’s charts (22.1 percent).

Lawsuit statistics
Beginning with the 1992 survey, the medical liability committee decided to exclude from the total those pediatricians who were sued only during their residencies. By excluding claims during residency, the percentage of pediatricians reporting a claim or suit for malpractice was 29.5 percent in 1992 compared to 27.9 percent in 1990. The percentage of pediatricians in 1992 who reported being a party to a claim or suit for malpractice while a resident is also nearly the same as reported in 1990 (8.4 percent as opposed to 9.5 percent). In all three surveys, pediatricians reported being sued an average of 1.6 times. These differences are not statistically significant.

In 1992, 65.5 percent of the pediatricians reported the hospital as the site of the alleged malpractice compared to 67.3 percent in 1990 and 69.7 percent in 1987. In 1992, 32.1 percent of pediatricians reported the alleged malpractice occurred in the office, compared to 25.1 percent in 1990 and 28.3 percent in 1987. The differences in response between years for either site are not statistically significant. However, the proportion of respondents reporting that alleged malpractice occurred at a site other than the office or hospital showed a statistically significant increase in 1992, as it did in 1990 from that of 1987.

In both the 1992 and 1990 surveys, the survey asked about the influence of malpractice issues on pediatrician participation in community-based activities. About the same proportion of respondents in both years said they participated in community-based activities (53.8 percent in 1992 and 55.5 percent in 1990). In 1992, among those who did not participate, 11.4 percent named the fear of a malpractice suit as a reason for not participating; in 1990, 14.5 percent gave that reason. Only 2.3 percent of nonparticipating pediatricians named the inability to get malpractice coverage as a reason for not participating in 1992 and 1.8 percent did so in 1990. These differences are not statistically significant.

There are no significant differences between years in the proportion of pediatricians reporting type of health insurance for patients filing a claim or suit. Fourteen percent of pediatricians in 1992 reported that plaintiffs were uninsured. This does not differ significantly from the percentage of pediatricians who reported uninsured plaintiffs in 1990 (19.6 percent) and in 1987 (15.2 percent). These differences are not statistically significant.

There is also no significant difference in the percentage of pediatricians in 1992 (65.9 percent) who reported plaintiffs with private health insurance compared to 1990 (62.9 percent) and 1987 (66.9 percent). Pediatricians reporting plaintiffs with public health insurance was 20.1 percent in 1992 compared to 17.5 in 1990 and 17.9 in 1987.

To receive a complete index of topics that have been included on the Periodic Survey of Fellows, contact the AAP Department of Research at (800) 433-9016, ext. 7630. Through the Periodic Survey Index, specific questions on any of the topic areas can be searched.