Which Patients Are Most Likely to Sue EP? There's No Particular Profile
Individual patient-physician interaction is far more predictive
When an emergency physician (EP) receives notice of a lawsuit, the plaintiff often turns out not to be the first patient who comes to mind, says Jonathan D. Lawrence, MD, JD, FACEP, an EP and medical staff risk management liaison at St. Mary Medical Center in Long Beach, CA.
"The squeaky wheels are not necessarily the ones who are going to get a lawyer," he says. "Lawsuits tend to come out of left field — you get the subpoena and say, 'Who the heck was that patient?'" In Lawrence's experience, demanding, unpleasant patients, "are not the ones you end up in court with."
No Particular Patient Profile
A patient with significant brain or spinal cord injury that requires ongoing care is likely to file suit, irrespective of whether actual negligence occurred, notes Rade Vukmir, MD, JD, FACEP, FACHE, chairman of education and risk management at ECI Healthcare Partners, a Traverse City, MI-based provider of emergency and acute care management services. Vukmir is chief clinical officer of National Guardian Risk Retention Group and clinical professor of emergency medicine at Temple University, Philadelphia, PA.
While some EPs believe disadvantaged patients are more likely to sue, a recent study shows that the opposite is probably true.1 "There is clear evidence that people at a financial disadvantage actually sue less," says Vukmir. "People often don't sue because of money. There are more complex reasons that people sue their doctor."
The patient-physician interaction on an individual basis is more predictive of whether a suit will be filed than any particular patient population, or even whether negligence occurred, emphasizes Vukmir. "The distinguishing factor seems to be a communication issue," he says. "And there are factors that involve both parties."1-3
Generally speaking, EPs who tend to engage patients in conversation, demonstrate caring, and utilize humor appropriately in their interactions are sued less often, according to Vukmir. "The expectation of perfection is seldom achievable in any profession," he says. "But on any given day, EPs should strive to optimize effective communication and advocate for the patient as much as they can."
Whether a particular ED patient will file suit "is a more complicated dynamic than simply asking which groups are more commonly involved," says Vukmir. A better question to consider might be "Which EPs are more likely to be sued?"
"Patients will sue if they feel they haven't been heard or haven't had an audience with the EP," Vukmir says. "Unfortunately, that's more common in some specialties than others." EPs first need to recognize they are practicing in a high-risk medical-legal environment, says Vukmir, and "actively focus their practice to avoid that circumstance."
Areas of particular concern in EDs are well-known, he says, and include changes of shift, patient transfers, and on-call consultants. "The most important thing is to deliver the best quality patient care," says Vukmir. "Never do anything in the ED that makes you uncomfortable from a patient care perspective."
Vukmir acknowledges that circumstances or decisions are often imposed from outside the ED, and may be related to the admission process, a consultant, or hospital capability — "but EPs should strive to protect their patients as much as they can."
- McClellan FM, White AA, Jimenez J, et al. Do poor people sue doctors more frequently? Confronting unconscious bias and the role of cultural competency. Clin Orthop Relat Res 2012;470(5):13931397.
- Moore PJ, Adler NE, Robertson PA. Medical malpractice: The effect of doctor-patient relations on medical patient perceptions and malpractice intentions. West J Med 2000;173(4):244-250.
- Huntington B, Kuhn N. Communication gaffes: A root cause of malpractice claims. Proc (Bayl Univ Med Cent). 2003;16(2):157-161.
- Hickson GB, Jenkins AD. Identifying and addressing communication failures as a means of reducing unnecessary malpractice claims. N C Med J. 2007;68(5):362-364.
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