The effect of emotional intelligence on malpractice “is very underestimated and undervalued,” says Daniel Shouhed, MD, faculty at Cedars-Sinai Medical Center in Los Angeles.
Physicians with more complaints are more likely to be sued.1 Shouhed and colleagues wanted to know if the same was true for physicians with lower emotional intelligence.
In a literature review, the researchers found no studies specifically about emotional intelligence and malpractice risk. However, Shouhed and colleagues’ findings suggest an indirect negative correlation between a physician’s emotional intelligence and litigation risk.2 Shouhed, the study’s lead author, says this is because better communication skills mean happier patients: “When you have unhappy patients, you’re more likely to get a malpractice claim.”
The researchers’ previous work focused on human factors that result in errors.3 “No matter how perfect you think a system is, there are going to be errors that occur,” Shouhed says, noting these include system issues, or active failures on the part of the EP. “But not all adverse events result in litigation. That’s where we think emotional intelligence comes in.”
The many unique challenges of the ED setting (no pre-existing relationship with patients, for one thing) makes emotional intelligence all the more important. “Somehow, you have to make that connection so the patient believes that you are truly there to help them,” Shouhed advises.
An EP who conveys no compassion, makes no eye contact, and takes no time to explain what is going on is not making that connection. If anything goes wrong, or appears to go wrong, patients may be highly motivated to at least consider calling a malpractice attorney.
Shouhed says displaying good emotional intelligence in the ED does not have to be extremely complicated. It is as simple as the EP asking before discharge (with sincerity), “Did we answer all your questions? Is there anything we could have done better?”
The patient or family might volunteer some information that can help matters. Someone might express intense worry over a specific family history and wish a CT scan had been ordered.
This new information about risk factors might result in the EP deciding to order the test after all. The point is not to order additional tests just because the person demands it, but more to engage in dialogue on concerns that might otherwise go unvoiced. “Sometimes, it can be a very simple thing to get a patient to leave happy rather than upset,” Shouhed observes.
Interventions to enhance physicians’ level of emotional intelligence early in their careers could be a way to limit future legal action. “The question is, is it teachable? Or is it more of an innate skill?” Shouhed asks.
It might depend in part on the physician’s age. “It’s harder to teach emotional intelligence to someone who’s older,” says John Tafuri, MD, FAAEM, regional director of emergency medicine at Cleveland (OH) Clinic and chief of staff at Fairview Hospital, also in Cleveland.
Some patients openly state that they initiated lawsuits, at least in part, because the physician was perceived as rude and uncaring. “If you know how to interact with people, you can dramatically reduce your malpractice risk,” Tafuri says.
The Cleveland Clinic has a no-tolerance policy when it comes to inappropriate behavior with colleagues. “That transfers over to how they deal with patients as well,” Tafuri says.
If an EP is identified as having low emotional intelligence, based on poor satisfaction scores or a disproportionate number of complaints, there are a few approaches EDs can take. “You can pressure or persuade people to take courses to promote emotional intelligence,” Tafuri suggests.
Showing EPs how things look from the patient’s point of view is particularly effective. One ED leader made videos taken from the patient’s perspective, depicting how things went from the moment they walked into the ED. In one scene, an EP does not sit next to the patient; instead, the EP looks down at the patient in a condescending way. That EP was unaware of how arrogant he seemed until he watched the video.
“That made many people, including myself, realize that how you come off is so important,” Tafuri says. “It really hits you right in the face with how you are perceived.”
Tafuri knows firsthand how powerful emotional intelligence can be in preventing malpractice litigation. Years ago, after Tafuri controlled the airway of a 35-year-old overdose patient with endotracheal intubation, an ED nurse placed an orogastric tube incorrectly, resulting in the patient’s death.
“It was tragic and unfortunate. Had we not told them, the family would, at least initially, not have known why the gentleman passed away,” Tafuri says. Tafuri brought the family in and honestly spoke about what had happened. “Here was a case that probably would have been a slam dunk medical legal case, at least from the hospital standpoint. There was never a lawsuit filed,” he says.
In fact, the family members, one by one, each hugged the nurse who was sobbing in the hallway. “The vast majority of people will give you the benefit of the doubt if you treat them with respect,” Tafuri says. “If you come off as arrogant, there is no question it won’t go as well.”
This surprising outcome to a terrible mistake shows that respectful treatment in the ED goes further than one might expect to prevent lawsuits. “It’s really a shame when that does not happen, even when there is not a bad outcome,” Tafuri adds. “It’s just not right.”
The formal study of emotional intelligence should be a requirement for everyone in healthcare, says Andrew P. Garlisi, MD, MPH, MBA, VAQSF. In the ED, says Garlisi, “contact times with patients are short and high-intensity. Time to decisions are condensed, and serial tasking is the rule rather than the exception.”
Some EDs offer training focused on better patient satisfaction scores. “The extent to which these relatively simple techniques are effective is highly variable, dependent on many factors,” says Garlisi, medical director of Geauga County EMS and University Hospitals’ EMS Institute Paramedic Training Program in Ohio.
Such training usually covers addressing family members present in the room, touching the patient, sitting to establish eye level contact, providing a warm blanket or pillow, informing the patient of the anticipated waiting time for labs and radiology studies, and discussing test results and anticipated disposition. “Most patients who visit the ED experience some combination of physical, emotional, and spiritual pain and suffering,” Garlisi says.
This manifests as anger, concern, worry, anxiety, fear, depression, and panic. The emotionally intelligent EP, says Garlisi, “understands and anticipates that the patient most likely has symptoms and issues that lie beneath the obvious physical manifestations. These also require attention.”
Addressing only the physical complaints does the patient and the EP a disservice. “It may disrupt an otherwise satisfactory doctor-patient relationship,” Garlisi says. Likewise, the EP who manages to meet the patient’s emotional needs creates a stronger relationship. “Patients who make the emotional connection to the doctor are less likely to sue that physician in the event of an untoward event,” Garlisi adds.
- Shouhed D, Beni C, Manguso N, et al. Association of emotional intelligence with malpractice claims: A review. JAMA Surg 2019;154:250-256.
- Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA 2002;287:2951-2957.
- Catchpole K, Ley E, Wiegmann D, et al. A human factors subsystems approach to trauma care. JAMA Surg 2014;149:962-968.