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Not properly diagnosing a condition and nonmedical errors such as equipment failure accounted for more than half of the malpractice lawsuits against internists, a study found.

Researchers set out to find the reasons why internists were sued for medical malpractice and to determine how successful the lawsuits were. Results were in JAMA Internal Medicine.

, a cardiologist at Bassett Medical Center in Cooperstown, N.Y., and colleagues reviewed nearly 250,000 cases submitted to the , a trade association that represents medical liability insurers. The cases were closed between 1985 and 2009. While submission is voluntary, the group processes more than 60% of the 45,000 estimated claims that are brought annually.

Of those 250,000 cases, researchers extracted the 33,747 (13.7%) that involved internal medicine physicians.

"These data confirm that internists are vulnerable to claims related to what they do commonly -- evaluation and management activities -- and for the commonly fatal diseases that they are expected to diagnose, such as acute myocardial infarction and lung, colon, and breast cancers," the authors wrote.

The five most common reasons internists were sued were:

1. Harm caused by failure to correctly diagnose primary medical condition (26.4% of all closed claims)

It seems like a no-brainer that improper diagnosis would top a list of why any doctor would be sued for malpractice, but that is especially the case for specialties whose primary job is to diagnose patients. The exception might be a field such as surgery, where most of the work is procedural and not diagnostic.

"I wouldn't be surprised in other primarily procedural-oriented specialties, the problem isn't diagnosis but actual improper performance," Mangalmurti told 番茄社区 in an telephone interview.

Under this category, 33.8% of closed claims were paid, with a median payment of $183,300.

2. Breach of care due to other failures (25.4% of all closed claims)

The second most common reason of being sued includes events that happen but aren't actual mistakes in terms of the administration of medical care. Examples include failure to obtain consent or equipment failure.

"It's something where you wouldn't necessarily blame the doctor for a mistake in medical judgment," Mangalmurti said. "It's more external factors that come into play when it comes to the practice of medicine and can still result in injury."

This is an issue physicians need to be aware of, he said. It's not just about making the right decision but can be about factors out of their hands.

Under this category, 4.8% of closed claims were paid, with a median payment of $114,150.

3. Harm caused by errors in actual performance of a procedure (11.1% of all closed claims)

While this would appear to be another obvious cause of malpractice lawsuits for physicians, less than a third (28.3%) of cases actually resulted in a payment to patients to compensate for damages; the median payment was $103,203.

4. Harm caused by failure to monitor subordinates such as a nurse or residents (10.9% of all closed claims)

"There are definitely situations where any reasonable observer would feel like a physician shouldn't be held responsible for mistakes that are made by a nurse or by a resident," Mangalmurti said. "But there are certainly some situations where the subordinate is acting as a surrogate or an extension of the physician."

He recommended using common sense, monitoring the work staff do when appropriate, and setting expectations for them.

Under this category, 31.1% of closed claims were paid, with a median payment of $141,875.

5. Harm caused by incorrect prescription or administration of medications (8.5% of all closed claims)

Examples here include not asking for known allergies, giving incorrect dosage, or giving a drug with known side effects and not checking for signs of those adverse events.

Under this category, 29.2% of closed claims were paid, with a median payment of $89,600.

Other less common reasons for being sued for malpractice included harm from unrecognized complications of procedures (3.6% of all closed claims), harm from failure to perform medically indicated procedures (2.7% of all closed claims), and harm from not performing a medically indicated consultation in a timely manner (2.3% of all closed claims).

The success of lawsuits and payment amounts were similar to previous findings and work in other subspecialties, the paper noted.

Researchers did find wide variation in what resulted in a payout to a patient.

For example, more than 40% of claims from failing to refer patients and 38% of claims from not performing a procedure resulted in a payment. Meanwhile, less than 5% of the claims because of nonmedical judgment errors such as equipment failure resulted in a payment.

There was less variation in payment amounts, which ranged from more than $183,000 for incorrect diagnosis to less than $90,000 for incorrect prescription or medication administration.

Mangalmurti and colleagues found largely similar results when examining the top reasons why cardiologists were sued for medical malpractice. "This is part of a larger research agenda that we have, which is to really begin to explore the clinical characteristics of malpractice suits," he told 番茄社区.

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