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Background: Diagnostic errors lead to patient harm; however, most research has been conducted in nonsurgical disciplines. We sought to characterize diagnostic error in the pre-, intra-, and postoperative surgical phases, describe their contributing factors, and quantify their impact related to patient harm. Methods: We performed a retrospective analysis of closed medico-legal cases and complaints using a database representing more than 95% of all Canadian physicians. We included cases if they involved a legal action or complaint that closed between 2014 and 2018 and involved a diagnostic error assigned by peer expert review to a surgeon. Results: We identified 387 surgical cases that involved a diagnostic error. The surgical specialties most often associated with diagnostic error were general surgery (n = 151, 39.0%), gynecology (n = 71, 18.3%), and orthopedic surgery (n = 48, 12.4%), but most surgical specialties were represented. Errors occurred more often in the postoperative phase (n = 171, 44.2%) than in the pre- (n = 127, 32.8%) or intra-operative (n = 120, 31.0%) phases of surgical care. More than 80% of the contributing factors for diagnostic errors were related to providers, with clinical decision-making being the principal contributing factor. Half of the contributing factors were related to the health care team (n = 194, 50.1%), the most common of which was communication breakdown. More than half of patients involved in a surgical diagnostic error experienced at least moderate harm, with 1 in 7 cases resulting in death. Conclusion: In our cohort, diagnostic errors occurred in most surgical disciplines and across all surgical phases of care; contributing factors were commonly attributed to provider clinical decision-making and communication breakdown. Surgical patient safety efforts should include diagnostic errors with a focus on understanding and reducing errors in surgical clinical decision-making and improving communication. Contexte : Les erreurs de diagnostic causent des préjudices à la patientèle; par contre, la majeure partie de la recherche a porté sur d'autres disciplines que la chirurgie. Nous avons voulu caractériser les erreurs de diagnostic susceptibles de survenir lors des périodes pré-, per-, et postopératoires, en décrire les facteurs contributifs, et mesurer leur impact sur le plan des préjudices causés à la patientèle. Méthodes : À partir d'une base de données représentant plus de 95% de tous les médecins canadiens, nous avons procédé à une analyse rétrospective des dossiers et des plaintes de nature médico-légale réglés. Nous avons inclus tous les dossiers ayant donné lieu à une poursuite judiciaire ou à une plainte officielle qui ont été réglés entre 2014 et 2018 et qui, après expertise, mettaient en cause une erreur de diagnostic imputée à un chirurgien ou une chirurgienne. Résultats : Nous avons recensé 387 cas chirurgicaux associés à une erreur de diagnostic. Les spécialités chirurgicales les plus souvent impliquées dans une erreur diagnostique étaient la chirurgie générale (n = 151, 39,0%), la gynécologie (n = 71, 18,3%), et la chirurgie orthopédique (n = 48, 12,4%), mais la plupart des spécialités chirurgicales étaient représentées. Les erreurs se sont produites plus fréquemment durant la période postopératoire (n = 171, 44,2%) que durant les périodes pré- (n = 127, 32,8%) ou peropératoires (n = 120, 31,0%). Plus de 80% des facteurs contributifs impliquaient le personnel soignant, la prise de décision clinique en étant le principal. La moitié des facteurs contributifs avaient à voir avec l'équipe soignante (n = 194, 50,1%), et le plus fréquent concernait un quelconque bris de communication. Plus de la moitié des cas ayant fait l'objet d'une erreur de diagnostic ont subi des préjudices au moins modérés, et 1 fois sur 7, l'issue en a été fatale. Conclusion : Dans notre cohorte, les erreurs de diagnostic ont touché la plupart des disciplines chirurgicales et toutes les périodes opératoires; les facteurs contributifs ont souvent été liés à la prise de décision clinique et à un bris de communication. Les efforts déployés pour assurer la sécurité de la patientèle devraient aussi tenir compte des erreurs de diagnostic et mettre l'accent sur l'analyse et la prévention des erreurs associées à la prise de décision clinique et sur l'amélioration de la communication., The diagnostic process is a foundational element of every medical specialty, both surgical and nonsurgical. In any clinical practice, the diagnostic process involves information gathering (via history taking, physical examination, [...]

PURPOSE COVID-19 has increased the need for innovative virtual care solutions. Electronic consultation (eConsult) services allow primary care practitioners to pose clinical questions to specialists using a secure remote application. We examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on response times and referrals, and the content of clinical questions being asked. METHODS This was a mixed-methods analysis of eConsult cases submitted between March and September 2020 in Ontario, Canada to 2 services. We performed a descriptive analysis of the average response time and the total time spent by the specialist for eConsults. Primary care practitioners completed a post-eConsult questionnaire that asked about the outcome of the eConsult. We performed an inductive and deductive content analysis of a subset of cases to identify common themes among the clinical questions asked. RESULTS A total of 208 primary care practitioners submitted 289 eConsult cases. The median specialist response time was 0.6 days (range = 3 minutes to 15 days); the average time spent by specialists per case was 16 minutes (range = 5 to 59 minutes). In 69 cases (24%), the eConsult enabled avoidance of a face-to-face referral. Content analysis of 51 cases identified 5 major themes: precautions for high-risk and special populations, diagnostic clarification and/or need for COVID-19 testing, guidance on self-isolation and return to work, guidance on personal protective equipment, and management of chronic symptoms. CONCLUSIONS This study demonstrates the considerable potential of eConsults during a pandemic as our service was quickly implemented across Ontario and resulted in primary care practitioners' rapid and low-barrier access to specialist input. Key words: primary care; electronic consultation; Coronavirus 2019; COVID-19; referral; specialist care; telemedicine; remote consultation; public health; health information technology; organizational change; practice-based research Ann Fam Med 2022;20:220-226. https://doi.org/10.1370/afm.2807, INTRODUCTION As a result of the COVID-19 pandemic, many countries have initiated lockdowns to help limit spread of the virus. (1) In Ontario, Canada's most populous province, the provincial government [...]

Background: Medico-legal complaints against physicians are a significant source of anxiety and could be associated with defensive medical practices that may correlate with poor patient outcomes. Little is known about patient concerns brought to regulatory bodies and courts against dermatologists in Canada. Objective: To characterize factors contributing to medico-legal complaints brought against dermatologists in Canada. Methods: The Canadian Medical Protective Association (CMPA) repository was queried for all closed cases involving dermatologists over the past decade. Aggregate, anonymized data was reviewed and case outcomes, patient harm, and contributing factors were extracted. Results: Nearly one-fifth of all dermatologists who are CMPA members have been named in at least one medico-legal case between 2013 to 2022. A total of 396 civil-legal actions or College complaint cases involving dermatologists were closed at the CMPA during this timeframe. The most common patient allegations were deficient assessment (34%), diagnostic error (28%), and unprofessional manner (22%). Nearly half of patients experienced a harmful event, the majority of which were asymptomatic or mild. The most frequently identified contributing factors related to providers were poor clinical decision making (n = 73), lack of situational awareness (n = 67), and conduct and boundary issues (n = 59). Team factors included a breakdown of communication with patients (n = 124). Conclusions: Improved communication with patients for informed consent, treatment plans, clinical follow-up, and documentation of thorough clinical patient assessments can improve patient satisfaction and health outcomes, and mitigate dermatologists' medico-legal risk. [ABSTRACT FROM AUTHOR]

This review identifes the factors influencing the relationship between physicians and patients that can lead to patients' dissatisfaction and medical complaints. Utilizing a systemic approach 92 studies were retrieved which included quantitative, qualitative, and mixed method studies. Through a thematic analysis of the literature, we identified three interrelated main themes that can influence the relationship between physicians and patients, patients' satisfaction, and the decision to file a medico‐legal complaint. The main themes include patient and physician characteristics; the interpersonal relationship between physicians and patients; and the health care system and policies, with relevant subthemes. These themes are demonstrated in a descriptive model. The review suggests areas of focus for physicians who may wish to increase their awareness around the potential sources of relational problems with their patients. Identifying these issues may assist in improvements in the therapeutic relationship with patients, can reduce their medico‐legal risk, and enhance the quality of their clinical practice. The findings can also be utilized to support andragogical principles for medical learners. The article can serve as a structured framework to identify potential problems and gaps to design and test effective interventions to mitigate these potential relational problems between physician‐patient. [ABSTRACT FROM AUTHOR]

Background: Dementia increases as individuals age. Aging physicians represent a growing population. Studies have demonstrated there are physicians with cognitive impairments practicing medicine. The medico‐legal consequences of physicians with cognitive impairments have not been investigated. Methods: The Canadian Medical Protective Association (CMPA) is a national medical association with 108,000 members who advise and assist doctors with medico‐legal matters. They maintain a national repository of legal actions and complaints to regulatory bodies and hospitals. We looked at civil‐legal and regulatory college cases closed over a 10‐year period associated with physicians aged ≥55. A word search of the cases was conducted using "Dementia, Alzheimer, Cognitive impairment, Cognitive decline, Memory loss, Memory issues, Fit for/to practice." Results: The CMPA closed 67,566 cases between 2012 and 2021 and 16% (10,599) involved members ≥55. A mixed methodology approach identified 65 cases associated with physician's cognitive ability to practice medicine. Of these 65 cases, the average age of physician was 71.3 (56.1–88.5). The proportion of cases where concern was associated with a physician's cognitive ability to practice medicine increased, from 0.2% of cases in 55–60‐year‐olds, to 7.7% in physicians over 80. Interpretation: As physicians age, concerns about cognitive impairment are more likely to contribute to medico‐legal matters. [ABSTRACT FROM AUTHOR]