Publication: Sex differences in medico-legal action against doctors: a systematic review and meta-analysis

14 August 2015

Male doctors are nearly two and half times as likely to have medico-legal action taken against them than their female counterparts, according to research published in BMC Medicine by a team including CHIME’s Dr Henry Potts. A better understanding of why this is the case will lead to improved support for doctors and make patient safety better.

The number of medico-legal actions taken against doctors is rising. In the US, between the years 2008 and 2012 there has been a 17 per cent increase in the number of medical licenses that have been revoked, denied or suspended. The UK medical regulator - the General Medical Council - has seen a 64 per cent increase in complaints between 2010 and 2013.

Some previous studies have looked at the sex differences and medico legal action in specific countries, but none have examined this globally. To investigate these differences on an international level and whether there have been changes over time, the team conducted a systematic review and meta-analysis. They identified and analysed the results of 32 studies. This represented a population of 4,054,551, which included 40,246 cases of medico-legal action.

The results of the systematic review and meta-analysis found that male doctors were more likely than female doctors to have medico-legal action taken against them, with nearly two and half times the odds. This was found to be consistent across a number of years, different study types and across the countries included in the investigation.

The researchers divided medico legal action into categories:

  • Disciplinary action taken against a doctor by a medical regulatory board;
  • Malpractice claims/cases;
  • Complaints received by non-regulatory bodies that investigate healthcare complaints;
  • Criminal cases;
  • Medico-legal matter with a medical defence organization.

This last category relates to any studies that grouped together several medico-legal action types.

It has been previously believed by some that male doctors are more likely to experience medico-legal action as more male doctors were practicing medicine. Had this been the case, the differences between sexes would have reduced over time due to the growing number of female doctors. This analysis has shown that the difference between the sexes has remained consistent for the last 15 years.

Other studies have shown that male doctors work more hours than female doctors, and have more interactions with patients. This may have an influence on the differences in the likelihood of medico-legal action. Further research is needed to confirm if there are any associations with these two factors.

Lead researcher, Dr Emily Unwin (UCL Medical School), said: "Investigating complaints about doctors’ fitness to practice not only places an enormous level of stress on the doctor being investigated, but also places a resource strain on regulators, and may lead to patient concerns about the quality of care they receive."

“More research is needed to understand the reasons for why male doctors are more likely to experience a medico-legal action.  The causes are likely to be complex and multi-factorial.  The medical profession, along with medical regulators, and medical educationalists, now need to work together to identify and understand the underlying causal factors resulting in a sex difference in the experience of medico-legal action, with the aim of better supporting doctors in achieving the standards expected of them, and improving patient care."

Reference: Unwin E, Woolf K, Wadlow C, Potts HWW, Dacre J (2015). Sex differences in medico-legal action against doctors: A systematic review and meta-analysis. BMC Medicine, 13, 172.

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