Study assesses physician workplace and psychosocial factors as predictors of medical negligence claims

Physicians with lower self-rated health and life satisfaction, and those who experienced a recent serious injury or illness, are more likely to be sued by patients for medical negligence, according to a new study.1

Researchers analyzed data from 12,134 doctors in Australia and found psychosocial and workplace factors associated with risks of being sued. Those are in addition to risks of lawsuit against older surgeons with high workloads, long work hours and history of prior claims, said the study, published this month in the BMJ Open of the British Medical Journal.

“This suggests that the quality of treatment and workplace support offered to doctors experiencing recent illness or injury can impact on patient care,” the authors wrote. “Our results also reinforce pervious recommendations that preventive efforts to improve doctors’ health and well-being need to be intensified.”

“It is critical that we try to better understand why some doctors are sued. A mistake by a doctor can have tragic consequences for patients and can be costly for the health system,” corresponding author Owen Bradfield, a fellow of the Royal Australian College of General Practitioners, said in a news release.

“Patients who suffer harm from a medical error can sue the doctor concerned in order to seek redress, answers, and assurances that mistakes will not be repeated,” said Bradfield, medical lawyer and doctoral candidate at the Centre for Health Policy, Melbourne School of Population and Global Health at the University of Melbourne. “Therefore, understanding why that doctor made a mistake and was sued can help us reduce medical errors and improve healthcare quality.”

The study examined responses of physicians in the Medicine in Australia Balancing Employment and Life (MABEL) survey. Doctors answered questions about their age, sex, specialty, personality, health, life satisfaction, working conditions and previous lawsuits.

Among the group, 649 reported being named in a medical negligence claim, including 268 general practitioners.

Based on sex, working in a regional area, low self-rated life satisfaction and not achieving work-life balance, along with increasing age, predicted negligence claims for male doctors. Working more than part-time hours and having recent personal injuries or illnesses predicted claims for female doctors.

“Personality type predicted claims in both male and female doctors,” the study said. The researchers “found that agreeableness, unlike other personality types, conferred a modest protective effect on the risk of being sued.”

While prior studies have not found a consistent association between personality type and risk of lawsuit, agreeableness is associated with empathy, which may improve professionalism and communication. “Personality may influence how a doctor responds following and adverse event, and this may also determine the risk of medical litigation,” with patients possibly less angry and less likely to sue doctors who express genuine empathy and regret, the authors wrote.

The researchers advised cautious interpretations for associations of work hours and perceptions about job control, with medicolegal risk. For example, greater risk due to physician work hours could be explained by increased patient volume, while doctors in highly structured workplaces may feel they have less autonomy, but may have well-defined scopes of practice, surgical safety checklists or patient safety initiatives that reduce medical errors.

The study noted a relative undersupply of physicians in regional and remote areas of Australia, with similar problems in the United States and Canada. Physicians in regional settings had greater risk of lawsuit than those in remote areas – a surprising finding because generally they expected risk to increase with geographic remoteness. Explanations could include increased amounts of procedural work at small hospitals and less familiarity with patients that leads to errors from lack of continuity of care.

Reference

1. Bradfield OM, Bismark M, Scott A, Spittal M. Vocational and psychosocial predictors of medical negligence claims among Australian doctors: a prospective cohort analysis of the MABEL survey. BMJ Open. 2022. doi: 10.1136/bmjopen-2021-055432