Medico-Legal Cases Involving Cardiologists and Cardiac Test Underuse or Overuse

Evidence-based campaigns are available to support appropriate diagnostic testing in cardiology, but medico-legal concerns can impede implementation. We conducted a retrospective descriptive analysis of medico-legal cases (civil legal, regulatory authority, hospital matters) involving cardiologists in Canada. For eligibility, cases must have closed at the Canadian Medical Protective Association between January 1, 2009 and December 31, 2018. We defined test underuse and overuse using criticisms in the medico-legal record from peer experts, regulatory authorities, or hospitals. We used a contributing factors framework and descriptive statistics for analysis. From 2009 to 2018, the Canadian Medical Protective Association closed 60,598 cases with 368 (0.6%) involving a cardiologist. Within those cases, there was no criticism of cardiac diagnostic test overuse and 15 cases (4.1%) with criticism of underuse (tests not ordered, not expedited, delayed). In 12 of 15 cases of underuse (80.0%), the patient experienced severe harm or death. Of 8 civil legal cases, 6 were decided in favour of the plaintiff (75.0%) and 2 were dismissed by consent before proceeding to trial (25.0%). Decisions on regulatory authority matters did not favour the cardiologist (7 of 7 cases). In all cases of underuse, there was need for focused testing to investigate new or worsening symptoms. The most common contributing factors included clinical decision-making, situational awareness, and communication with teams and patients. Medico-legal cases involving cardiologists and the overuse or underuse of cardiac diagnostic tests were extremely rare in Canada, despite the potential for harm. The criticisms of cardiac diagnostic test underuse related to issues with diagnosing symptomatic patients. Même s’il existe des campagnes fondées sur des données probantes visant à promouvoir le recours aux tests diagnostiques appropriés en cardiologie, il arrive que des préoccupations d’ordre médico-légal nuisent à la réalisation de ces tests. Nous avons réalisé une analyse descriptive rétrospective des affaires médico-légales (poursuites au civil et plaintes déposées auprès d’organismes de réglementation et d’hôpitaux) touchant des cardiologues au Canada. Ont été retenus pour l’analyse les dossiers clos à l’Association canadienne de protection médicale entre le 1er janvier 2009 et le 31 décembre 2018. La sous-utilisation et la surutilisation de tests ont été définies à partir des critiques formulées dans les