P187 The scope of litigation in gastroenterology. (19th June 2022)

• Record Type: Journal Article
• Authors: O'Neill, Parker; Schaffer, Sierra; O'Neill, Fallon; Poullis, Andrew
• Is Part Of: Gut. Volume 71(2022)Supplement 1
• Page Start: A131
• Page End: A132
• Publication Date: 2022-06-19
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BSG.241
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Gastroenterology is known as a high-risk litigious specialty and with medical litigation on the rise, physicians may begin to demonstrate risk reduction strategies. In order to practice safely, gastroenterologists should have a clear understanding of the case law surrounding physician litigation and how this has most commonly been applied in practice. This study aims to highlight the events that incur the most litigation, the laws most commonly involved, and to summarise how these can best be navigated to limit liability. Methods: A bibliometric analysis of the Web of Science (WoS) Core Collection database was performed with the MeSH terms 'litigation' OR 'malpractice' OR 'lawsuit' AND 'gastro*'. The top 50 most-cited articles were extracted and analysed. A scoping review was performed to compare the case law surrounding medical litigation in the UK and the USA. Results: A total of 289 articles were identified on the WoS, with 129 articles being excluded due to not meeting the inclusion criteria. of the top 50 articles, 62% were from American institutions and 10% were from the UK. The American Journal of Gastroenterology published 30% and the Journal of Gastrointestinal Endoscopy published 8% of the top 50 articles. Over the past 50 years, gastroenterology litigation articles have been steadily receiving more citations with the record of 73 citations occurring in 2021. The maximum number of articles published in a year was six litigation articles in 2008. Thematic analysis showed 42% of articles pertained to litigation in endoscopy, 20% related to the diagnosis and treatment of gastrointestinal cancer, 8% about medications, 8% regarding inadequate consent, 8% about defensive medicine practices, and 14% about other themes. In order to be found clinically negligent in the UK and the USA, it must be proven that a) the physician had a duty of care, b) that the duty of care was breached, and c) that the breach of duty directly led to patient harm. Furthermore, the UK Wilsher case demonstrated that junior doctors owe the same standard of care as qualified physicians and therefore must remain vigilant and seek advice from seniors often. Conclusion: Gastroenterologists in the UK and the USA are at increased risk of litigation due to the high volume of procedures and ongoing pressure to accurately detect colorectal cancer. Current understanding of the case law is vital to ensure physicians are not found clinically negligent and juniors should always seek advice in the case of uncertainty. Overall, gastroenterologists would benefit from further legal training and support to enable them to reduce their liability while still practicing evidence-based medicine.