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<p>Skin cancer management is a prevalent area for medico-legal cases against dermatologists. Previous medico-legal studies have mainly been conducted in the United States, which differs from countries with publicly funded health care systems. Understanding medico-legal trends can guide strategies to improve patient safety. Medico-legal case data was extracted from the Canadian Medical Protective Association’s (the national physician mutual defense association representing 95% of Canadian physicians) repository. Cross-sectional analysis was conducted on cases closed between 01/01/2016-12/31/2020 with skin cancers as the presenting, diagnosed, or complicating condition. 120 of 17,277 closed cases involved skin cancer (melanoma 41%, basal cell carcinomas 25% and squamous cell carcinomas 16%). Dermatologists (28%), family physicians (28%) and plastic surgeons (12%) were commonly named. Allegations of delays related to a wrong or missed diagnosis (60%), deficient assessment (43%) and failure to recommend further investigations (26%) were most common. Diagnostic error was seen in 52% of cases and the remainder had factors contributing to diagnostic error including inadequate monitoring/follow-up, failure/delay in performing therapeutic/diagnostic interventions, insufficient documentation, or deficient patient assessments. Unreported or cases not closed at the time of data extraction were not captured. In addition to diagnostic errors, certain healthcare provider factors were found to be associated with increased medico-legal risk. Inadequate documentation, patient monitoring or follow-up, deficient assessments, communication breakdown with the patient and the healthcare team and failure or delay to perform a diagnostic test or intervention were the top contributing factors identified in cases. Strategies to reduce medico-legal risk could include addressing knowledge or communication deficiencies and ensuring that informed consent is adequately achieved. Specific interventions can include participation in continuing education events and technologic innovations to assist with management of patient and test result follow up.</p>

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The medico-legal risks of skin cancer management: an analysis of Canadian cases

  • 期刊论文

  • 发表日期：

    2026年5月22日

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  • Jeffrey Toy,
  • Yvonne Deng,
  • Chaocheng Liu,
  • Laura Payant MScN,
  • Richard Liu,
  • Gary Garber,
  • Tashmeeta Ahad

摘要

Skin cancer management is a prevalent area for medico-legal cases against dermatologists. Previous medico-legal studies have mainly been conducted in the United States, which differs from countries with publicly funded health care systems. Understanding medico-legal trends can guide strategies to improve patient safety. Medico-legal case data was extracted from the Canadian Medical Protective Association’s (the national physician mutual defense association representing 95% of Canadian physicians) repository. Cross-sectional analysis was conducted on cases closed between 01/01/2016-12/31/2020 with skin cancers as the presenting, diagnosed, or complicating condition. 120 of 17,277 closed cases involved skin cancer (melanoma 41%, basal cell carcinomas 25% and squamous cell carcinomas 16%). Dermatologists (28%), family physicians (28%) and plastic surgeons (12%) were commonly named. Allegations of delays related to a wrong or missed diagnosis (60%), deficient assessment (43%) and failure to recommend further investigations (26%) were most common. Diagnostic error was seen in 52% of cases and the remainder had factors contributing to diagnostic error including inadequate monitoring/follow-up, failure/delay in performing therapeutic/diagnostic interventions, insufficient documentation, or deficient patient assessments. Unreported or cases not closed at the time of data extraction were not captured. In addition to diagnostic errors, certain healthcare provider factors were found to be associated with increased medico-legal risk. Inadequate documentation, patient monitoring or follow-up, deficient assessments, communication breakdown with the patient and the healthcare team and failure or delay to perform a diagnostic test or intervention were the top contributing factors identified in cases. Strategies to reduce medico-legal risk could include addressing knowledge or communication deficiencies and ensuring that informed consent is adequately achieved. Specific interventions can include participation in continuing education events and technologic innovations to assist with management of patient and test result follow up.