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OBJECTIVE An analysis of malpractice lawsuits judged in court compared with those mediated in court may help explain perceptions of malpractice risk. METHODS We conducted a retrospective study of malpractice lawsuits mediated and judged in court using data from district courts in Beijing from 2010 through 2014. We evaluated the number of cases, the payment amount, and the time to resolution, by resolution type. Patient age, sex, the severity of injury, and adverse event type were measured. Subsequently, a binary logistic regression identified factors associated with patients' pursuit of judgment. RESULTS Between 2010 and 2014, there were 1226 lawsuits (49.9%) mediated in court and 1259 (50.1%) judged in court. The proportion of the judged lawsuits varied significantly across the study period (p < 0.001). The mean payment amount and the time to resolution were significantly higher in judgment lawsuits (p < 0.001). The younger the patients, the greater the possibility of being judged in court (odds ratio [OR] = 0.831, p < 0.0001). Lawsuits where the adverse event type was treatment, obstetrics, or diagnostics were more likely to be judged than those where the adverse event type was surgical (OR = 2.311, p < 0.0001; OR = 2.311, p < 0.0001; OR = 3.302, p < 0.0001, respectively). When lawsuits were for a temporary injury, they were more likely to be judged in court than those for a permanent injury (OR = 0.723, p = 0.0139).results CONCLUSIONS: The patient-physician relationship may in fact not be particularly close in our country. Lawsuits with certain characteristics tend to be judged in court. Understanding these characteristics may be useful for predicting the outcome of lawsuits against physicians. CONCLUSIONS