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General Practitioners at Risk of Missing Cardiovascular Disease

  • June 27, 2017

Study Investigates Misdiagnosis of Patients with Heart Problems

Boston, Massachusetts—June 27, 2017— When doctors miss a diagnosis of cardiovascular disease in an outpatient setting, the patient often has conventional risk factors for coronary artery disease, a groundbreaking study reveals. The research, published online today in The Joint Commission Journal on Quality and Patient Safety, was performed by CRICO Strategies and The Doctors Company.

Researchers looked at 251 closed medical malpractice cases where patients alleged that the general medical practitioner who treated them in an outpatient setting missed a cardiovascular diagnosis. These cases were more likely to result in higher severity injury than malpractice claims in general, the study showed.

Key findings included:

  • Almost a quarter of the patients in the analysis who were eventually diagnosed with myocardial infarction or coronary atherosclerosis had a history of prior cardiovascular disease—one of the highest pretest predictors of cardiovascular disease.

  • The majority of patients with missed outpatient coronary artery disease had initial diagnoses that were either nonspecific or common disease mimics (for example, esophageal reflux or musculoskeletal pain), despite the high prevalence of cardiovascular risk factors among those patients.


“What was most surprising from these results was cardiovascular malpractice claims in outpatient general medicine occur predominantly in patients with typical risk factors of cardiac disease rather than in low-risk patients,” said Gene R. Quinn, MD, MS, MPH, co-author of the study. “In short, physicians aren’t just missing the hard diagnoses.”

Researchers concluded that prior to diagnosing esophageal disease or using a nonspecific diagnosis in ambulatory patients, general medical practitioners should consider that patients with certain comorbidities such as diabetes, tobacco use, or previous cardiovascular disease may be suffering from cardiovascular disease.

“We are proud to partner with CRICO on this important research that shines a light on risks that others may not see,” said co-author Darrell Ranum, vice president of patient safety and risk management, The Doctors Company. “These findings will help guide quality improvement efforts to decrease diagnostic error and improve patient safety. The next step is research into designing simple, scalable, and easily implemented interventions to prevent errors in diagnosis of patients at high risk of cardiac disease.”

About The Doctors Company
Founded and led by physicians, The Doctors Company ( is in medicine. The Doctors Company takes the mal out of malpractice insurance by helping practices of all sizes manage the complexities of today’s healthcare environment—with expert guidance, resources, and coverage. The Doctors Company is the nation’s largest physician-owned medical malpractice insurer, with 79,000 members and over $4 billion in assets, and is rated A by A.M. Best Company and Fitch Ratings. To learn more about data-driven insights and to stay up to date on industry trends, follow and subscribe to The Doctors Company on Twitter (@doctorscompany), YouTube, LinkedIn, Facebook, and Google+.

About CRICO Strategies                                                    

CRICO Strategies ( is a division of The Risk Management Foundation of the Harvard Medical Institutions Incorporated, a CRICO company. Through participation in our national Comparative Benchmarking System (CBS), business, clinical, and patient safety leaders can leverage their malpractice data to identify clinical risks, benchmark against peers, and engage clinical leadership. CBS represents more than $25 billion in reserves and losses and reflects the medical professional liability experience of more than 400 hospitals and health care entities and 165,000 physicians from commercial and captive insurers nationwide, representing approximately 30 percent of all US medical malpractice claims.