Medico-legal cases involving gastroenterologists in Canada between 2017 and 2021

Gastroenterology may be a medical specialty with higher-than-average medico-legal risk. We evaluated the characteristics of medico-legal proceedings relating to the delivery of gastroenterology medical care in Canada during a five-year time period.

We used a repository of Canadian medico-legal cases to identify cases between 2017 and 2021 involving a gastroenterologist. We analyzed patient, provider, team, and system contributing factors using a previously published Contributing Factors Framework and patient harm using a previously published coding system.

We identified 223 cases involving 229 gastroenterologists with no preponderance by years of experience. Gastroenterologists had a higher rate of civil legal actions than the average for all other physician specialties in the database. 59% involved patients older than 50 years of age, 10% with digestive tract malignancies, and 10% with IBD. 51% of involved patients had a healthcare-related harm that had a negative effect on their health or quality of life. 35% had avoidable harm. Patients most commonly reported a perception of deficient assessment (35%), communication breakdowns (27%), unprofessional manner (25%), diagnostic error (22%), and inadequate monitoring or follow-up (20%). 50% of cases were criticized by peer experts, of which they deemed 45% involved communication breakdown with patients, 38% involved clinical decision-making, 30% situational awareness, 25% documentation, and 15% communication among providers.

Communication issues remain a major contributing factor to medico-legal cases involving gastroenterologists. Integrated risk-reduction strategies may include enhancing diagnostic rigor through improved clinical protocols and decision support tools and strengthening communication at all levels of care.