Practice of Medicine


Reducing the Risks of an Adverse Drug Reaction

Adverse drug reactions account for 4% of medical malpractice claims among internal medicine doctors insured by MagMutual. With the increasing complexity of prescription meds, adverse reactions to drugs remain a challenge in modern healthcare and present an increased risk to internal medicine physicians. 

To help internal medicine doctors reduce that number, MagMutual’s medical faculty and risk consultants have analyzed our claims data, determined the main causes of claims related to adverse drug reactions and developed strategies to improve patient outcomes. 

Top Risks

The main causes of claims related to adverse drug reactions are:

  • Failure to Review Results
  • Patient Monitoring
  • Failure to Order Indicated Testing

    Top Strategies for Reduction

    Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

    Clinical strategies

    • Discuss the high-risk side effects of every new medication. Include why the medication is being recommended, how to monitor for signs of an adverse reaction or toxicity, and what to do if symptoms of potentially dangerous reactions develop.
    • Schedule appropriate monitoring diagnostic studies when starting a new medication. Examples include Lasix and interval basic metabolic panel, and Warfarin and scheduling CBC to accompany INR check, especially when first starting the medication.

    Operational strategies

    • For more commonly prescribed medications, create a patient education handout for possible side effects, more concerning reactions, monitoring instructions and what to do if side effects or reactions occur.
    • Develop succinct, provider-facing reference material for recommended lab and imaging monitoring for higher risk medications and common drug interactions.
    • At every appointment, review patient allergies (or side effects) and all medications (both prescribed and over-the-counter).
    • Develop instruction sheets for patients, outlining a plan for holding and restarting anticoagulation. Sometimes the date to restart the medication is unclear, but the patient should understand the plan is to restart the medication when it is safe. When it is based on the surgeon's recommendation after a procedure, make sure the patient knows to clarify the plan with the surgeon when being discharged from the hospital or surgical center. When it is based on medical condition (like GI bleed), make sure the patient knows to clarify this with the treating physician. A CHADS2 VACS score should be calculated and used in conjunction with ACC guidelines to provide clear decision-making regarding the appropriate use of anticoagulation.
    • Opioid prescribing involves conducting a thorough evaluation of the patient's medical history, including any previous substance abuse issues or risk factors for addiction, screening for high-risk sedative hypnotic medication and alcohol use, as well as using prescription drug monitoring programs to identify potential misuse. Additionally, healthcare providers should prescribe the lowest effective dose for the shortest duration necessary, provide education on the risks and side effects of opioids, and explore non-opioid alternatives or multimodal pain management strategies whenever possible. Be aware of the federal and state laws surrounding opioid prescribing for acute pain management.

    Other Top Risks

    Though adverse reactions to drugs account for a significant number of claims among internal medicine doctors according to our data, we’ve identified several other drivers of loss based on claims frequency, and severity:

    Risk Drivers by Top Cause
    Top Clinical Key Loss Driver Loss CauseTop Non-Clinical Contributing Factor% of Claims
    (A) CancerDiagnosticCommunication7%
    (B) InfectionTreatmentDocumentation6%
    (C) Medication ordering errorTreatmentDocumentation6%
    (D) Adverse drug reactionTreatmentCommunication4%
    (E) Spinal abscessDiagnosticDocumentation2%
    (F) DiabetesTreatmentDocumentation1%

    Risk Drivers by Frequency


    Download the full report with strategies to help you reduce risk in all key areas that drive claims

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    Data Collection & Methodology

    Data is based on MagMutual closed claims data from 2011-2021 and corresponding exposure data. Clinical and non-clinical loss drivers are based on an in-depth review of each claim by a medical professional or clinical risk consultant. Risk reduction strategies are based on input from practicing physicians.


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    The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.