Great Communication Skills = Lower Risk of Malpractice

By Edward Leigh, MA

A friend who worked as an oncology social worker for many years told me of a pediatric oncologist who was working with young cancer patient. The oncologist accidentally gave her a very large (and potentially fatal) dose of chemotherapy. The young girl survived this medical error. My first thought — that girl's parents will immediately go to an attorney. However, that was not the case.

The oncologist spoke to the girl's parents and explained what happened. She said she felt terrible and said, "I'm sorry." She also said, "Based on what happened I think it would be best if your daughter worked with another oncologist." The parents said, "We don't want another oncologist. You have been so wonderful to our daughter. You were there holding her hand when she was ill from the various treatments. We want you to continue treating our daughter — we won’t have it any other way!" By the way, they also told the oncologist they had no plans to take legal action.

Why did the parents have no intention of pursuing litigation? One simple reason – they liked the oncologist. In general, people don't sue people they like. We get people to like us through great communication skills.

The June 4, 1997 issue of the Journal of the American Medical Association (JAMA) included an enlightening article called, "Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons." The primary objective was to identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons. The research compared the communication behaviors of "claims" vs. "no-claims" physicians using audiotapes of 10 routine office visits per physician. The study consisted of 59 primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. The physicians were classified into no-claims or claims. There was significant differences in communication behaviors of no-claims and claims physicians in the primary care physicians group (no differences in surgeon group). The helpful behaviors exhibited by the no-claims primary care physicians included:

Length of primary care office visit
The study demonstrates a strong correlation between extra time spent with patients and lower frequency of malpractice claims. Since patients dislike feeling rushed or ignored, physicians who are "too busy" to sit down, listen attentively, and respond to a patient’s questions may set the stage for problems down the road.

Engaging in a dialogue
Physicians should encourage two-way communication that includes:

• using orientation statements, which educates patients about what to expect and the flow of a visit. This includes statements such as, "First, we'll talk about your stomach pain, then I will examine you, and then we will talk about ways to treat the problem."
• applying facilitation techniques to obtain patients' opinions, check for understanding and encourage patients to talk. These include questions such as, "What do you think is causing the pain?"
• using applications of humor, laughter and encouraging statements, such as "I'm happy to hear you are feeling better." Use of humor and laughter express warmth, friendliness and empathy and builds a bond between physician and patient.
• inquiring into psychosocial and lifestyle issues, such as, "You said you went on an anniversary cruise last month, how was it?"
• providing information and advice, such as by making a statement like this, "The medication may make you feel sleepy." This also includes providing educational literature and suggesting organizations to contact. Imparting information and advice in a manner that demonstrates the physician’s genuine caring tends to diffuse patient anger and resentment.

Physicians who have been sued for malpractice often cite "unrealistic expectations" on the part of their patients. Encouraging two-way communication helps the patient develop appropriate expectations about a medical visit, and prompts the sharing of critical information.

Breakdowns in communication between physician and patient fuel distrust and pent-up anger. No one wants to feel that their concerns are ignored, nor that their problems have been minimized or disregarded. Factor in a bad outcome to the scenario and we are setting the stage for a lawsuit. On the other hand, effective communication skills tends to enhance patient satisfaction.

The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings to improve communication and decrease malpractice risk.

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