Reducing the Risk of Malpractice

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Reducing the Risk of Malpractice

Physicians who are extremely competent medically may still be likely to face a malpractice suit during their careers. The good news is that the physician can significantly reduce the likelihood by implementing some behavioral changes relating to his or her patients.

In Healing Words: The Power of Apology in Medicine, second edition, by Michael S. Woods, M.D., the author presents a number of research studies which conclude that problematic experiences with one’s doctor are strongly correlated with the risk of a subsequent lawsuit.

In one study, 71% of the plaintiffs had had poor relations with their physician before any incident occurred. The researchers cited four factors underlying the suits:

The patients believed that their doctors had deserted them. The patients believed that their doctors had discounted their concerns. The patients believed that their doctors had not provided adequate information. The patients believed that their doctors did not understand their (or their families’) perspectives.

Another researcher, Wendy Levinson, M.D., “found that the physicians with the best communication skills were also those who had not been sued. The former tended to ask more questions, encourage patients to talk about their feelings, use humor when appropriate and educate patients about what to expect during treatment. These physicians also spent more time with patients than those who had been sued.” After reviewing the length of office visits, she found that the physicians who had never been sued spent an average of three additional minutes with their patients.

Interestingly, women physicians are often more skilled at developing good patient relationships as they tend to be better listeners and express more empathy. Thus, male physicians are three times more likely to face a malpractice charge. “Men are more likely to be raised to avoid showing signs of weakness...many males seem to consider saying ‘I’m sorry’ to be the equivalent of admitting defeat, of rolling over and showing their throats ...” in the words of one researcher.

A significant study cited by Dr. Woods comes from Gerald Hickson, M.D. and his researchers at Vanderbilt University Medical Center. In this study, a few physicians generated the most complaints. “... A history of numerous complaints was an indicator that a physician runs a higher risk of being sued.” Those physicians who faced the most lawsuits were identified by their patients as not listening or returning phone calls, rude, and lacking respect.

In the case of a medical error, patients are much less likely to sue if the physician apologizes. Patients want to hear the words “I’m sorry” from their doctors. The American College of Physician Executives looked at medical mistakes and found that doctors who tried to cover up or hide an error were 92% more likely to be sued.

Physicians can avoid some charges of malpractice by “making it a habit to always treat their patients with honesty and respect, including offering apologies when they are in order rather than waiting until they are ordered.”

Patients and families want to hear the following:

What happened? How will this affect my health in the short term? In the long term? Why did this happen? What is being done to treat the problem I have now? Who will bear the cost of this error or complication? What will you do to protect other patients from a similar mistake?

Dr. Woods makes the case in his book for sincere apology in the case of a medical error. Apology is not to be confused with causation, but instead expresses empathy and concern. One of the five components of apology, according to the author, is staying engaged. He cites some examples of cases where the physician who lost the patient attended the funeral or did something especially noteworthy. Families were particularly affected by the continuing involvement of the treating physician.

Ken Vuylsteke, J.D., in an article titled, “An Imperfect Shield: Suggestions to Avoid a Malpractice Suit”, published by the St. Louis Metropolitan Medicine magazine, stated:

A family seeks closure following the death of a loved one. The family’s knowledge that the physician did all that medical science could do and also valued the life of the deceased, allows them to accept the sad truth that medicine cannot guarantee the perpetuation of life. The failure to personally and sincerely share this loss with the patient’s family is a leading cause for my office phone to ring.

The Missouri Physicians Health Program understands what devastating effects a malpractice suit has on the physician, his family, and often his associates. It is for this reason that we are publishing this article in an effort to lessen the likelihood of unnecessary suits. In subsequent issues, we will be publishing articles on the anatomy of a malpractice suit and what the physician’s spouse needs to know to cope with this very challenging process.