Learning from primary care malpractice: past, present and future

• patient safety
• medical errors
• malpractice
• primary care

“Medications that clean bile and phlegm are a source of danger, and of blame for the person treating”. Hippocrates. Affections 33.1

The tangled relations between disease, treatment, patient harm, medical fallibility, and physician culpability have been debated since classical times. But it is only historically recently that actions alleging negligence by doctors have become a commonplace feature of the health care landscape.

One hundred years ago an experienced Scottish judge, while hearing a legal case against an Edinburgh general practitioner (see box), commented on its rarity: “This action is certainly one of a particularly unusual character. It is an action of damages against a medical man. In my somewhat long experience I cannot remember having seen a similar case before.”2

Only a century later the medicolegal landscape of health care could hardly be more different. In the year 2000 the UK General Medical Council received 5000 complaints which alleged doctors’ misconduct or poor performance and National Health Service (NHS) hospitals in England faced 23 000 outstanding claims for compensation.3,4 The annual incidence of NHS written complaints concerning GPs’ behaviour or the organisation of primary health care in 2001 relating to GPs and community dentists amounted to 44 000, an increase of 12% on the previous year and …