Good Communication Is a Key Factor in Avoiding Malpractice Suits

Media Advisory Date: February 18, 1997

Primary care physicians who listen to their patients and use a more friendly manner during visits may reduce the risk that they will be sued for malpractice, reports a study funded by the Agency for Health Care Policy and Research (AHCPR). Results were published in the February 19 issue of the Journal of the American Medical Association.

Researchers, led by Wendy Levinson, M.D., of Oregon Health Sciences University and Legacy Good Samaritan Hospital and Medical Center, Portland, Oregon, audio taped at least 10 routine patients visits each with 59 primary care physicians and 65 general and orthopedic surgeons in Colorado and Oregon.

Subjects were randomly selected and were divided into two groups depending on their malpractice claims history. The 1,265 audiotapes were analyzed by coders who did not know whether the physicians fit into the "claims" or "no claims" group. The study found significant differences in communication styles between primary care physicians who had been filed against and those who had not. The differences for surgeons were not as clear.

Primary care physicians in the no claims group spent more time with patients during a routine office visit than those in the claims group, an average of 18.3 minutes to 15 minutes. In addition to length of the visit, researchers found several other differences in the interaction between physicians and patients. Primary care physicians in the no claims group were more likely to tell patients what was going to happen during the office visit by using phrases like, "First I'm going to examine you and then we will talk the problem over." These physicians, who had no malpractice claims filed against them, also asked patients for their opinions and elicited questions, and were more likely to use humor and laugh during an office visit.

Length of visits with surgeons did not have the same association as it did for primary care physicians. Furthermore, the study did not identify differences in communication styles that could predict the malpractice risk for surgeons. Researchers attribute this to several possibilities. One, routine office visits may not be as important for some surgeons. The critical times for surgeon communication may be when it is necessary to inform patients about bad news. Second, communication with surgeons may not be as important to patients initiating a malpractice claim as other factors, including true negligence, surgical complications, or financial incentives. Third, patients may not look to surgeons for interpersonal communication, but rather technical expertise presented in a more businesslike manner.

Researchers are conducting further quantitative analyses to gain more understanding into the communication patterns of surgeons, but they conclude, that "physicians can incorporate these behaviors into routine practice to improve their communication skills and decrease their malpractice risks."

Note: Dr. Levinson is now Chief of the Section of Internal Medicine at the University of Chicago.

For additional information, contact AHCPR Public Affairs: Karen J. Migdail, (301) 427-1855 ; Salina Prasad, (301) 427-1864.