Abstract
BackgroundPhysicians who perform unsafe practices and harm patients may be disciplined. In Norway, there are five types of disciplinary action, ranging from a warning for the least serious examples of malpractice to loss of licence for the most serious ones. Disciplinary actions always involve medical malpractice. The aims of this study were to investigate the frequency and distribution of disciplinary actions by the Norwegian Board of Health Supervision for doctors in Norway and to uncover nation-wide patient safety issues.MethodsWe retrospectively investigated all 953 disciplinary actions for doctors given by the Board between 2011 and 2018. We categorized these according to type of action, recipient’s profession, organizational factors and geographical location of the recipient. Frequencies, cross tables, rates and linear regression were used for statistical analysis.ResultsRural general practitioners received the most disciplinary actions of all doctors and had their licence revoked or restricted 2.1 times more frequently than urban general practitioners. General practitioners and private specialists received respectively 98.7 and 91.0 disciplinary actions per 1000 doctors. Senior consultants and junior doctors working in hospitals received respectively 17.0 and 6.4 disciplinary actions per 1000 doctors. Eight times more actions were received by primary care doctors than secondary care doctors. Doctors working in primary care were given a warning 10.6 times more often and had their licence revoked or restricted 4.6 times more often than those in secondary care.ConclusionThe distribution and frequency of disciplinary actions by the Norwegian Board of Health Supervision clearly varied according to type of health care facility. Private specialists and general practitioners, especially those working in rural clinics, received the most disciplinary actions. These results deserve attention from health policy-makers and warrant further studies to determine the factors that influence medical malpractice. Moreover, the supervisory authorities should assess whether their procedures for reacting to malpractice are efficient and adequate for all types of physicians working in Norway.
Highlights
Physicians who perform unsafe practices and harm patients may be disciplined
We considered general practitioner (GP) in general practice, GPs working in emergency primary care clinics and nursing home doctors as representing primary care doctors, while junior hospital doctors and senior hospital consultants were grouped as secondary care doctors
Because a disciplinary action is a sign of medical malpractice and a possible indicator of problems related to patient safety, we will discuss our findings in the context of the research aims
Summary
Physicians who perform unsafe practices and harm patients may be disciplined. The aims of this study were to investigate the frequency and distribution of disciplinary actions by the Norwegian Board of Health Supervision for doctors in Norway and to uncover nation-wide patient safety issues. In order to be disciplined, the physician must, through his or her medical conduct, have provided substandard or negligent care that led, or could have led, to patient harm [9, 10, 12]. In Norway, this process is the responsibility of the National Board of Health Supervision (NBHS), which receives the most serious patient complaints and assesses whether a doctor should be disciplined. In a few rare and extraordinary cases, civil courts impose additional legal penalties
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