General Principles

  • I. W. FongEmail author
Part of the Emerging Infectious Diseases of the 21st Century book series (EIDC)


To err is human and we all make mistakes, but this simple truth is not a satisfactory excuse for many of our affected patients, especially in developed countries. Despite the fact that many physicians will at sometime in their career encounter medical-malpractice litigation, we are ill prepared. It is, in fact, surprising that such an important topic is not included in the curriculum of all medical schools, and it is ignored to a large degree in post-doctoral training of residents and fellows. Physicians consider malpractice claims not only as a nuisance in their busy practice, but as unwanted events that result in anxiety, emotional pain, and possible loss of income and unnecessary expense.


Medical Malpractice Liability Insurance Malpractice Claim National Quality Forum Abnormal Test Result 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Sloan, FA, Chepke LN (eds), (2008), Medical Malpractice. MIT Press, Cambridge, MA.Google Scholar
  2. 2.
    Kohn LT, Corrigan JM, Donaldson MS (eds), (2002). To err is human; building a safer health system. National Academy Press, Washington, DC.Google Scholar
  3. 3.
    Studdert, DM, Mello MM, Brennan TA, (2004). Medical Malpractice. N Engl J Med. 350: 283–292.PubMedCrossRefGoogle Scholar
  4. 4.
    Studdert, DM, Mello MM, Gawande AA, Gandhi TK, Kachalia AB, Yoon C, Puopolo AL, Brennan TA, (2006), Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 354: 2024–2033.PubMedCrossRefGoogle Scholar
  5. 5.
    Annas, GJ (2006). The patient’s right to safety; improving the quality of care through litigation against hospitals. N Engl J Med. 354: 2063–2066.PubMedCrossRefGoogle Scholar
  6. 6.
    Marcus, HR, (Texas Alliance for Patient Access) (2006). Medical malpractice and patient safety (letter to the editor). N Engl J Med. 355: 735.PubMedCrossRefGoogle Scholar
  7. 7.
    Clinton, HR, Obama B, (2006). Making patient safety the centerpiece of medical liability reform. N Engl J Med. 354: 2205–2208.PubMedCrossRefGoogle Scholar
  8. 8.
    Liebman, CB, Hyman CS, (2004). A mediation skills model to manage disclosure of errors and adverse events to patients. Health Affairs (Millwood); 23: 22–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Canadian Medical Protective Association, (2005). The medical liability environment outside of Canada. CMPA;
  10. 10.
    Canadian Medical Protective Association, (2005). Medical liability in Canada: towards the right balance. CMPA;
  11. 11.
    Anderson GF, Hussey PS, Waters HR, (2005). Healthcare spending in the United States and the rest of the industrialized world. Health Affairs; 24: 903–914.CrossRefGoogle Scholar
  12. 12.
    Canadian Medical Protective Association, (2006). Medical liability – a physician primer. CMPA;
  13. 13.
    Gandhi TK, Kachalia AB, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, Studdert DM, (2006), Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann. Intern Med. 145: 488–496.PubMedGoogle Scholar
  14. 14.
    Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, Etchells E, Ghali WA, Hébert P, Majumdar SR, O'Beirne M, Palacios-Derflingher L, Reid RJ, Sheps S, Tamblyn R, (2004), The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ; 170: 1678–1686.PubMedGoogle Scholar
  15. 15.
    Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S, (2002), Adverse events in New Zealand public hospitals I: occurrence and impact. N Z Med J 115; U271.PubMedGoogle Scholar
  16. 16.
    Vincent C, Neale G, Woloshynowych M, (2001), Adverse events in British hospitals: preliminary retrospective record review. BMJ; 322: 517–519.PubMedCrossRefGoogle Scholar
  17. 17.
    Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH, (1991), Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 324: 370–376.PubMedCrossRefGoogle Scholar
  18. 18.
    Bartlett G, Blais R, Tamblyn R, Clermont RJ, MacGibbon B, (2008), Impact of patient communication problems on the risk of preventable adverse events in acute care settings. CMAJ; 178: 1555–1562.Google Scholar
  19. 19.
    Frankel A, (2008), Health literacy and harm; who is at risk? What is the fix? CMAJ; 178: 1573–1574.PubMedGoogle Scholar
  20. 20.
    Safe practices for better healthcare (2007), Washington DC: National Quality Forum (accessed June 01, 2007; at
  21. 21.
    Kraman SS, Hamm G., (1999) Risk management: extreme honesty may be the best policy. Ann. Intern Med. 131: 963–967.PubMedGoogle Scholar
  22. 22.
    Gallagher TH, Studdert D, Levinson W, (2007), Disclosing harmful medical errors to patients. N Engl J Med. 356: 2713–2719.PubMedCrossRefGoogle Scholar
  23. 23.
    Safer practice notice: being open when patients are harmed, (2005), London: National Patient Safety Agency (accessed June 1, 2007, at
  24. 24.
    Australian Council for Safety and Quality in Healthcare (2003), Open disclosure standard: a national standard for open communication in public and private hospitals following an adverse event in healthcare- 2003 update (at$File/OpenDisclosure-web.pdf.
  25. 25.
    Canadian Medical Protective Association, (2006), How to apologize when disclosing adverse events to patients. CMPA:
  26. 26.
    Hoffmann, AC, Sanbar SS, (2007), Spoliation: record retention, destruction, and alteration. In: Sanbar SS (ed), The medical malpractice survival handbook, American College of Legal Medicine, Mosby, Elsevier Inc., Philadelphia, PA, p45–53.CrossRefGoogle Scholar
  27. 27.
    Rich BA, (2007), Breach of the physician-patient relationship. In: Sanbar SS (ed), The Medical Malpractice Survival Handbook. American College of Legal Medicine, Mosby/Elsevier Inc, Philadelphia, PA, p133–143.CrossRefGoogle Scholar
  28. 28.
    Sanbar SS (ed), (2007), Etiology of malpractice. In: The medical malpractice survival handbook, American College of Legal Medicine, Mosby/Elsevier Inc, Philadelphia, PA, p119–132.Google Scholar
  29. 29.
    Hill HF, (2007), Lack of informed consent and refusal. In: Sanbar SS (ed). The medical malpractice survival handbook, American College of Legal Medicine, Mosby/Elsevier Inc, Philadelphia, PA, p153–164.CrossRefGoogle Scholar
  30. 30.
    Graber ML, Franklin N, Gordon, R, (2005), Diagnostic error in Internal Medicine. Arch. Intern Med. 165: 1493–1499.PubMedCrossRefGoogle Scholar
  31. 31.
    Poon EG, Gandhi, T, Sequist, TD, Murff, HJ, Karson, AS, Bates, DW. (2004), “I wish I had seen this test result earlier!” Dissatisfaction with test result management systems in primary care. Arch. Intern Med. 164: 2223–2228.PubMedCrossRefGoogle Scholar
  32. 32.
    Boohaker EA, Ward RE, Uman JE, McCarthy BD, (1996), Patient notification and follow-up of abnormal test results. A physician survey. Arch. Intern Med. 156: 327–331.PubMedCrossRefGoogle Scholar
  33. 33.
    Haas JS, Cook EF, Puopolo AL, Burstin HR, Brennan TA, (2000), Differences in the quality of care for women with an abnormal mammogram or breast complaint. J. Gen. Intern Med. 15: 321–328.PubMedCrossRefGoogle Scholar
  34. 34.
    Marcus AC, Crane LA, Kaplan CP, Reading AE, Savage E, Gunning J, Bernstein, B, Berek, JS, (1992), Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic based trial of three intervention strategies. Med. Care; 30: 216–230.PubMedCrossRefGoogle Scholar
  35. 35.
    Lett, D, (2008), Canada lags in standardized protocols for medical labs (News). CMAJ; 179: 125–126.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.St. Michael’s HospitalUniversity of TorontoTorontoCanada

Personalised recommendations