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Correlation Seen Between Communication Skills and Malpractice Risk Specific behaviors linked with reduced risk
There are specific communication behaviors that decrease or increase a primary care physician's risk of a malpractice lawsuit, according to an article in this week's issue of The Journal of the American Medical Association (JAMA).
Wendy Levinson, M.D., formerly of Oregon Health Sciences University and Legacy Good Samaritan Hospital and Medical Center in Portland, Oregon (now with University of Chicago) and colleagues analyzed communication behaviors of primary care physicians and surgeons.
Past research has indicated that quality of care and chart documentation are not the major determinants in a patient's decision to initiate a malpractice claim. When faced with a bad outcome, it has been documented that patients and families are more likely to sue a physician if they feel the physician was not caring and compassionate.
They write: "Despite this recognition, studies to date have not informed physicians which specific communication behaviors decrease or increase their malpractice risk."
Dr. Levinson and her colleagues tape recorded office visits at 120 physician offices in Oregon and Colorado with the consent of both physicians and patients to determine physician communication behaviors. Physicians were classified as "no-claims" if they had fewer than two claims filed agains them. Those with two or more claims filed against them in a lifetime fell into the "claims" category. Significant differences in communication behaviors of "no-claims" and "claims" physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, "no-claims" primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). "No-claims" primary care physicians spent more time in routine visits than "claims" primary care physicians (mean, 18.3 vs. 15 minutes).
Beneficial discussion identified by the authors were statements such as, "First I'll examine you and then we will talk the problem over" or "I will leave time for your questions."
"Orienting statements help the patient develop appropriate expectations about a medical visit. They may also inform the patient about when during the interview to raise concerns and may help to prevent patients from presenting new problems in the closing moments of the interview," the authors write.
"Facilitative comments include statements such as, 'Go on, tell me more about that.' They also include asking patients about their opinions about their medical problems or treatment such as 'What do you think caused that to happen?' or 'What do you think about taking these pills?' These comments allow patients to talk and also indicate physicians' interest in their opinions, confirming studies that indicate the importance of allowing patients to talk without interruption."
The authors conclude: "Physicians can incorporate these behaviors into routine office practice as they seek to improve their communication skills and decrease their malpractice risk. Continuing medical education programs can help primary care physicians improve their communication skills. Furthermore, malpractice prevention programs should not assume that the same skills are appropriate for different specialty groups. Further research on surgeons is needed to identify teachable skills that might improve communication and decrease malpractice risk."
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For more information: contact the AMA's Scot Roskelley at 312/464-4431. email: [email protected] AMA web site: http://www.ama-assn.org
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