More on Risk of Medicolegal Claims

Everyone knows that neurosurgery, orthopaedic surgery and plastic surgery are the specialities with the highest risk of medicolegal claims, with obstetrics and gynaecology hot on their heels. Psychiatry and paediatrics have the lowest risks. Also well known is the lower risk for female than male doctors (though this might be an artefact of number of patients cared for, as women see less patients per week on average than men). A recent study [1] went further and examined how risk changes according to number of previous cases of litigation claims. The answer: after controlling for age, speciality and sex, the risk rises with increasing number of previous claims. As with drivers, previous record is a good index of future risk. The CLAHRC WM Director believes that psychological testing cannot identify this risk, but welcomes comments. Interestingly, the increased risk with multiple previous cases of successful litigation diminishes gradually as time passes. Maybe the high-risk practitioners gradually improve their performance or restrict their range of practice.

— Richard Lilford, CLAHRC WM Director


  1. Studdert DM, Bismark MM, Mello MM, Singh H, Spittal MJ. Prevalence and Characteristics of Physicians Prone to Malpractice Claims. New Engl J Med. 2016; 374: 354-62.

One thought on “More on Risk of Medicolegal Claims”

  1. The State of Florida attempted to address the problem of multiple instances of malpractice with a “three strikes and you’re out” rule which was implemented in 2004. The implementation of this rule, together with other measures intended to enhance patient safety, has, for a number of reasons clearly outlined by Paul Barach (see:, resulted in unintended consequences that may mean the legislative changes had the opposite effect. A recent MRC highlight notice for methodological research for identifying and measuring spillover effects is therefore particularly pertinent (see: In the case of Florida, an interrupted time series analysis comparing claims before and after the ruling between Florida and appropriately selected control states, may shed some light on whether any apparent effect of the ruling was due to ‘malpractice-prone’ doctors upping sticks rather than risk a third malpractice ruling.

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