Physician-Patient Communication

The differences between physicians who are sued and those never sued are not explained by measurable differences in the quality of care they provide or their chart documentation, as assessed by peer reviewers. Only 2% of hospitalized patients injured as a result of negligence institute litigation. In this group of litigants, degree of patient satisfaction appears to be a critical factor. Patients and their families, when perceiving lack of caring or compassion by the physician, are more likely to sue in the face of a bad outcome. Communication problems have been identified in up to 70% of depositions for malpractice claims. Studies of clinicians with histories of malpractice claims demonstrate that their patients report feeling of being rushed, feeling ignored, and receiving inadequate explanations compared to the patients of never-sued physicians.

Audiotapes of 10 sequential office visits were reviewed in a group of 124 physicians, separated into two categories as 1) never-sued or 2) at least two claims made since graduation from medical school.

In primary care, differences noted between never-sued physicians and their comparators included greater overall length of visit, total number of communications, and more facilitating statements (e.g., asking patients’ opinions, checking their understanding, and connectors such as "go on, tell me more"). Never-sued physicians used more orientation (e.g., "Here’s what we will do today: First an examination, then some lab tests . . .") and more humor. The predictive accuracy of this model was 80%; however, for the surgeons analyzed in the study, no communication variables had a significant and independent effect.

Since errors and injuries will occur in the best of hands, skillful and sensitive communication may reduce the likelihood of economically and personally costly litigation ensuing.

Levinson W, et al. JAMA 1997;277: 553-559.