Physician-Patient Communication: The Relationship With Malpractice Claims Among Primary Care Physicians and Surgeons

Objective. —To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons. Design. —Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician. Settings. —One hundred twenty-four physician offices in Oregon and Colorado. Participants. —Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (≥2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty. Main Outcome Measures. —Audiotape analysis using the Roter Interaction Analysis System. Results. —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 longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons. Conclusions. —Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.

[1]  D. Simpson,et al.  A survey of sued and nonsued physicians and suing patients. , 1989, Archives of internal medicine.

[2]  W. Levinson Physician-patient communication. A key to malpractice prevention. , 1994, JAMA.

[3]  R. Frankel,et al.  The effect of physician behavior on the collection of data. , 1984, Annals of internal medicine.

[4]  M. Stewart,et al.  Patient-Centred Interviewing Part III: Five Provocative Questions. , 1989, Canadian family physician Medecin de famille canadien.

[5]  J. Tschann,et al.  Physician communication skills and malpractice claims. A complex relationship. , 1989, The Western journal of medicine.

[6]  R. Warnecke,et al.  Appraisal of the event as a factor in coping with malpractice litigation. , 1988, Behavioral medicine.

[7]  Judith A. Hall,et al.  Meta-analysis of satisfaction with medical care: description of research domain and analysis of overall satisfaction levels. , 1988, Social science & medicine.

[8]  M. Stewart,et al.  Communication patterns of primary care physicians. , 1997, JAMA.

[9]  F. Sonnenberg,et al.  Does Physician Performance Explain Interspecialty Differences in Malpractice Claim Rates? , 1994, Medical care.

[10]  E. Emanuel,et al.  Preserving the physician-patient relationship in the era of managed care. , 1995, JAMA.

[11]  W. Kukull,et al.  Outcome-Based Doctor-Patient Interaction Analysis: I. Comparison of Techniques , 1982, Medical care.

[12]  Robert Tibshirani,et al.  Cross-validation and other estimates of prediction error , 1993 .

[13]  Judith A. Hall,et al.  Gender in medical encounters: an analysis of physician and patient communication in a primary care setting. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[14]  Ann G. Lawthers,et al.  Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. , 1991 .

[15]  Modena E. H. Wilson,et al.  Pediatrician interview style and mothers' disclosure of psychosocial issues. , 1994, Pediatrics.

[16]  J. R. Cooper,et al.  Including narcotic addiction treatment in an office-based practice. , 1995, JAMA.

[17]  R. Strauss,et al.  Physicians and the communication of "bad news": parent experiences of being informed of their child's cleft lip and/or palate. , 1995, Pediatrics.

[18]  J. Rolph,et al.  Malpractice Claims Data as a Quality Improvement Tool , 1991 .

[19]  B. Efron,et al.  A Leisurely Look at the Bootstrap, the Jackknife, and , 1983 .

[20]  Judith A. Hall,et al.  Improving physicians' interviewing skills and reducing patients' emotional distress. A randomized clinical trial. , 1995, Archives of internal medicine.

[21]  D. Hedeker,et al.  Predicting risk for medical malpractice claims using quality-of-care characteristics. , 1992, The Western journal of medicine.

[22]  Daniel B. Mark,et al.  TUTORIAL IN BIOSTATISTICS MULTIVARIABLE PROGNOSTIC MODELS: ISSUES IN DEVELOPING MODELS, EVALUATING ASSUMPTIONS AND ADEQUACY, AND MEASURING AND REDUCING ERRORS , 1996 .

[23]  K. Whetten-Goldstein,et al.  The relationship between malpractice claims history and subsequent obstetric care. , 1994, JAMA.

[24]  R. Penchansky,et al.  Initiation of Medical Malpractice Suits: A Conceptualization and Test , 1994, Medical care.

[25]  R. Frankel,et al.  The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. , 1994, Archives of internal medicine.

[26]  W. Applegate Physician management of patients with adverse outcomes. , 1986, Archives of internal medicine.

[27]  Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer. , 1986 .

[28]  J. Shymansky,et al.  Medical Communication Behavior System: An Interactional Analysis System for Medical Interactions , 1986, Medical care.

[29]  M. Young,et al.  Why do people sue doctors? A study of patients and relatives taking legal action , 1994, The Lancet.

[30]  E. Clayton,et al.  Obstetricians' prior malpractice experience and patients' satisfaction with care. , 1994, JAMA.

[31]  S. Charles,et al.  Sued and nonsued physicians' self-reported reactions to malpractice litigation. , 1985, The American journal of psychiatry.

[32]  D. Goldberg,et al.  Improving the psychiatric skills of established general practitioners: evaluation of group teaching , 1987, Medical education.

[33]  Nancy R. Katz,et al.  Relations Between Physicians' Behaviors and Analogue Patients' Satisfaction, Recall, and Impressions , 1987, Medical care.

[34]  L. Fallowfield,et al.  Delivering Sad or Bad News , 1995 .

[35]  S. Kaplan,et al.  Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease , 1989, Medical care.

[36]  G. Lester,et al.  Listening and talking to patients. A remedy for malpractice suits? , 1993, The Western journal of medicine.