Analysis of the causes of improper medical decision-making in medical damage liability disputes in China: a text mining approach.

backgroundImproper medical decision-making is a key issue in healthcare disputes worldwide. In China, medical malpractice lawsuits related to improper decision-making are on the rise, but research on the patterns and underlying factors of such litigation is limited. This study aims to analyze the characteristics and patterns of medical decision-making malpractice cases in China, with the goal of providing reference points for judicial processes and offering policy recommendations to prevent and mitigate doctor-patient conflicts.

methodsThis study selected medical damage liability dispute cases from the China Judgments Online platform between 2018 and 2024. Python was used for data cleaning, Chinese word segmentation, and stop-word filtering. A total of 439 cases involving improper medical decision-making were included for analysis. A Latent Dirichlet Allocation (LDA) topic model was applied to identify major themes, and differential analysis was conducted to explore the relationships among hospital level, identification method, damage outcomes, and degree of responsibility.

resultsIn medical decision-making lawsuit cases, judicial identification requests were predominant, and patient death was more likely to trigger litigation. The medical parties often bore secondary responsibility. Statistically significant differences were found between hospital level and degree of responsibility (P = 0.034 < 0.05) and between hospital level and damage outcomes (P = 0.008 < 0.01). The LDA topic model revealed six main themes in the cases: medical behavior, evidence analysis, damage compensation, treatment effectiveness, patient rights, and legal applicability. Cluster analysis identified the main causes of improper decision-making, including insufficient informed consent, improper treatment plans, inadequate examinations, poor monitoring of conditions, insufficient consultations, incorrect diagnoses, improper medication, insufficient assessment, and lack of thorough patient history inquiry.

conclusionsImproper medical decision-making is closely related to the responsibility awareness and communication skills of healthcare providers. Insufficient informed consent and improper treatment plans are the primary causes of improper medical decision-making. Effective communication between doctors and patients is a common problem across hospitals at all levels. To reduce improper medical decision-making, the following measures are recommended: emphasizing informed consent to reduce decision-making risk, strengthening team collaboration to improve decision-making ability, conducting thorough examinations to reduce uncertainty, developing individualized treatment plans, and promoting clinical decision support systems to avoid information omission.