الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Medical malpractice is defined as any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient. Medical error can be defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve a goal. An error often results in an adverse event to the patient. Adverse events are the harms or injuries that result from an error during the management of the patient rather than the underlying patient condition, usually as an unintentional and unexpected occurrence. Achieving a safer health-care environment will lead to reductions in the incidence of medical errors and adverse events.
This survey was conducted on physicians working in health care facilities in Cairo to study their reported incidence of medical errors and exposure to litigation of malpractice; and to assess their knowledge and attitude toward medical liability.
The study included 580 physicians, most of them were in the age group (30-40 years) (67.4%) , females (83.3%), and held a master degree in their specialty (63.6%). The majority of them were specialists (46.6%), and have work experience for durations ranging from 2-5 years (43%).
Most of participants were knowledgeable about absence of medical responsibility if physician adhere to standard of care (86.2%), contributory responsibility of patient (82.6%), liability of hospital (80.7%) and criminal medical liability (69%). On the other hand, most of them did not know that obtaining patient’s consent before medical management doesn’t protect doctor from litigation (72.1%), patient can’t litigate doctor if there is no damage resulting from medical error (68.3%), and the burden to prove occurrence of medical error and damage in litigation of malpractice is on the patient (60.2%).
All respondent physicians agreed about the importance of patient’s consent for any medical procedure since it protects both the doctor and the patient. Most of them agreed about blaming doctors for any insufficiency in health care facilities even if this is not his responsibility (98.4%), importance of hospital role to increase doctor awareness of medical liability (97.7%) , over exaggeration of magnitude of medical liability and incidence of medical error by media (95.2%) , importance of medical error reporting system in hospital (91.7%) , benefit of insurance system against medical liability (89.1%) , work load and lack of guidelines protocol for management as leading factors for medical error (90.2% and 83.3% respectively ), imprisonment as improper punishment for medical liability .
As regard the reported incidence of medical errors, diagnostic errors were the most frequent errors reported by participants including missed diagnosis (73.4%), delayed diagnosis (71.3%) and wrong diagnosis (58.4%). Communication errors were the next common errors reported by participants either between medical team (53.4%) or with patient (47.5%). System error in form of improper functioning equipment was reported by (44.1%).
Regarding reported medication errors, improper drug dose was the most common error (43.1%) followed by wrong drug choice (41.8%) and wrong frequency of drug intake (41.1%).
Infection and contamination of surgical wound was the most common surgical error reported by participants (32.5%), followed by organ, vascular or nerve damage (23%). Inadequate preoperative preparation was the most common anaesthetic error (27.7%) followed by faulty local /regional anaesthetic technique (21.8%).
There were significant significant differences in the frequencies of reporting medical errors between the participants according to their personal characteristics (age, gender, job title, qualification, specialty, workplace, and work experience).
The most common risk factor of medical error, as reported by the participants, was work overload (62.8%), followed by insufficient experience (53.1%), and poor workplace design, inadequate availability or maintenance of equipment (45%). There was no statistically significant difference between the included categories of workplaces in the frequencies of the reported risk factors.
As regard the resulting damage from medical errors, financial damage was the most common type (31.7%), followed by mild -to- moderate physical damage (26.6%). Patient’s death was reported by 45 physicians (7.8%) and fetal death was reported by 8 physicians (1.4%).
Regarding the response to occurrence of medical error, consulting an expert to know how to avoid repeating the error was the most recommended response (88.8%), followed by informing the hospital and ask to improve the work conditions and staff qualification (36.5%), and disclosure to the patient (27.9%).
Previous litigations of malpractice was reported by 13.8% of the respondent physicians. In most of these litigations (76.2%), medical responsibility couldn’t be proven by the plaintiff, and the other litigations resulted in monetary compensation (7.5%), prohibition from medical practice (5%), or disbarment from Medical Syndicate (1.3%).
Medical Syndicate was the most recommended authority by the participants (54.8%) to investigate litigations of malpractice , followed by the workplace (38.8%). Fairness was the most common reason for choosing the investigating authority, followed by absence of severe penalty, and rapid procedure of investigation.
The present study found that the most common defensive practice by the participants was the unnecessary consultation of senior colleagues (either always (66.7%), or sometimes (27.4%), followed by unnecessary frequent follow-up (either always (58.6%) or sometimes (38.2%)).
Physicians who were litigated for malpractice had significantly greater frequencies of reporting these defensive practices: prescribing unnecessary medications, unnecessary hospitalization, referring the patient to another hospital, and unnecessary consultation from other specialists.
In conclusion, although participating physicians had sufficient knowledge of medical responsibility, they were not aware of the elements of medical liability. They have positive attitude towards disclosure, reporting, and discussion of medical errors, but they worry about the consequences of disclosure. Diagnostic errors was the most frequent errors, followed by communication errors, and improper drug dosage, and wrong drug choice.
It was recommended to increase physicians’ awareness of medical liability, and to implement a system for reporting of medical error and investigating its causes in the hospitals to prevent its occurrence.
CONCLUSIONS
Although participating physicians had sufficient knowledge of medical responsibility, they were not aware of the elements of medical liability.
They have positive attitude towards disclosure, reporting, and discussion of medical errors, but they worry about the consequences of disclosure.
Regarding the reported incidence of medical errors, diagnostic errors were the most frequent errors, followed by communication errors either between medical team or with patient. The most common medication error was the improper dosage, followed by wrong drug choice.
Infection and contamination of surgical wound was the most common surgical error, followed by organ, vascular or nerve damage. Inadequate preoperative assessment and preparation was the most common anaesthetic error, followed by faulty local or regional anaesthetic technique.
The most common risk factor of medical errors was the heavy workload, followed by lack of protocols for clinical management.
Regarding the resulting damage from medical errors, financial damage was the most common type, followed by mild to moderate physical damage.
The most common defensive medicine practice by the participants was the unnecessary consultation of an expert, followed by unnecessary frequent follow-up. There was an association between previous litigation of malpractice and defensive medicine practices.
RECOMMENDATION
Physicians’ awareness of medical liability should be increased though education programs, and on job training.
Hospitals have an important role in implementing a system for reporting of medical error and investigating its causes to prevent its occurrence.
Hospitals should support the doctors through the process of disclosure of medical errors to alleviate their stress and encourage them to discuss its causes.
An insurance system for medical liability and litigations of malpractice should be adopted by health care system in Egypt.
Raising public awareness of the difference between complications and medical errors, and the difference between system errors and true negligence is recommended to decrease the fruitless lawsuits against medical professionals.
There should be collaboration between healthcare authorities and the media to promote the understanding of the adverse events in health care, and to regenerate confidence in healthcare professionals.
Health institutions should provide a better working environment for workers by reducing working hours, reconsidering the system of shifts, and ensuring adequate supervision by senior staff to decrease the risk of medical errors.
Hospitals should integrate systems that ensure effective communication between all members of the medical team.
Physicians should be trained to have good communication skills toward both patients and colleagues.
It is recommended to establish special authority for investigation of claims of malpractice in a professional and fair manner.
Physicians should be encouraged to adhere to the standard of care to avoid lawsuits of professional negligence.
Involvement of clinical pharmacists in management of the patients will help to decrease medication errors.