[Analysis of expert reports from a general practice expert in disciplinary cases and malpractice claims against family practitioners (1994-2000): a lesson for clinical practice].
Of the reports issued by a general practice expert for disciplinary and malpractice cases in the period 1994 to August 2000, 76 were analysed, with the emphasis on the more serious cases. Infectious diseases and cardiovascular diseases together formed 42% of the cases judged. The starting point of the analysis was the practice of an 'average general practitioner'. On the basis of jurisprudence and general practice literature, failure to diagnose a rare illness was not automatically regarded as reproachable but failing to estimate the seriousness of a situation was. In the first place it was checked whether or not general practitioner had adequately estimated the seriousness of the situation by paying due attention to the alarm signals and risk factors and in the case of diagnostic doubts by ensuring adequate follow-up. According to the analysis, 41% of the cases clearly exhibited reproachable conduct. This figure was twice as high when a locum was working at a practice. Two-thirds of the primary errors were due to the seriousness of the situation not being adequately estimated as a result of too little attention being paid to alarm signals and risk factors as well as a failure to ensure adequate follow-up. On the basis of the analysis it is advised that the use of a locum should be regarded as a risk situation: better information can be made available by means of an electronic patient file and unequivocal agreements for drawing up reports. For each consultation, the GP must systematically check whether there are alarm signals or risk factors. In the case of diagnostic doubts the clinical picture should be actively followed up by means of clear follow-up appointments at definite times. In the guidelines of the Netherlands Society for General Practitioners, explicit attention should be given to alarm signals and risk factors. In medical training and ongoing professional education, systematic training should be provided in the recognition of serious situations and rare diseases/complications.
de Melker
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D000328:Adult; D002648:Child; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005104:Expert Testimony; D005194:Family Practice / Q000331:legislation & jurisprudence* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data*; D008499:Medical Records / Q000592:standards*; D009426:Netherlands; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies