How are medico-legal issues perceived by OBGYN specialists?

A cross sectional survey of the perceptions and experiences of Obstetricians and Gynecologists in
Ethiopia

Alula M. Teklu, Feiruz Surur, Delayehu Bekele, Munir Kassa, Berhanu Kebede, Ananya Solomon

Introduction: One of the common challenges encountered by the ObGyn specialists is medico-legal
issues including litigations for medical malpractice, law suits for medical errors and others. The
magnitude of the challenges, perceptions and concerns are not well known. This study looked at these
factors.

Methods: a cross sectional assessment of current encounters, experiences and perceptions of practicing
ObGyn physicians who attended the Ethiopian Society of Obstetricians and Gynecologists conference in
February, 2016. Self-administered semi-structured questionnaire was used to collect the data.
Descriptive statistics was done to determine the magnitude of the different issues in relation to medico-
legal issues and bi-variable analysis was done to identify factors that correlated with perceived
commitment of malpractice. The cut off of p value <0.05 was used to determine significance.

Results: A total of 108 OBGYN were interviewed, mean age of the participants was 42 years (standard
deviation of 8 years) and only 10% were women. More than 50% of them worked in Addis Ababa and
same proportion worked in the public sector.

Nearly a third (36%) admitted of making at least one error, 23% have been accused of malpractice, 15%
(n=16) were questioned by police/attorney and 7% (n=7) were imprisoned. 83% of those who were
questioned were declared free. 80% (n=86) claimed to know someone who was accused of malpractice
unfairly. The odds of perceived malpractice among OBGYNs were 4.7 (95% CI 1.82 to 12.35, p<0.05)
times higher among those who ever committed medical errors previously while it was 3.26 (95% CI 1.33
to 8.02, p<0.05) times higher among those who were verbally abused by clients or their attendants.
There was no association with being questioned by legal bodies, being accused of malpractice, being
imprisoned, or being physically abused.

44% (n=47) were not aware of the roles of federal ethics committee and 47% (n=49) did not feel ready
to handle medical error and 88% (n=91) believed they will not get a fair treatment in case of
malpractice. More than two third of the respondents believed malpractice insurance is the gateway.

Conclusion: Many ObGyn are neither knowledgeable nor ready for management of medical error. There
is a huge concern about the fairness of the treatment they receive for medical error lawsuit. Fear of
litigation is enormous.

Recommendations: improving awareness about medical errors and their management paired with
creating clarity on the roles of the federal ethics committee is highly needed. Bridging the gap between
the judiciary system and the ObGyn society and addressing the disparity between the perceived
susceptibility and the reality are crucial.