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. 2021 Aug 24;11(8):e050377.
doi: 10.1136/bmjopen-2021-050377.

Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

Elizabeth E Austin  1 , Vu Do  2 , Ruqaiya Nullwala  2 , Diana Fajardo Pulido  2 , Peter D Hibbert  2 , Jeffrey Braithwaite  2 , Gaston Arnolda  2 , Louise K Wiles  2   3 , Tahlia Theodorou  2 , Yvonne Tran  2 , Reidar P Lystad  2 , Sarah Hatem  2 , Janet C Long  2 , Frances Rapport  2 , Annette Pantle  4 , Robyn Clay-Williams  2
Affiliations

Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance

Elizabeth E Austin et al. BMJ Open. .

Abstract

Objective: To identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners.

Design: Systematic review.

Data sources: Ovid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched.

Results: Sixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out.

Conclusions: It is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor's risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm.

Prospero registration number: PROSPERO registration number: CRD42020182045.

Keywords: clinical governance; health & safety; health policy; human resource management; risk management.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flow diagram for study selection. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Figure 2
Figure 2
Publication year of included studies.
Figure 3
Figure 3
The number of publications for each factor associated with doctors at risk of malpractice claims and/or complaints, or impaired performance.
See this image and copyright information in PMC

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