Communication or lack of communication by physicians to their patients increases the vast majority of malpractice claims. The physicians’ behavior and relationships with their patients, rather than any single medical mistake, contributes to claims being brought against them. The physician-patient relationship may erode over a period of time. For example, the physician is consistently late and never apologizes. The physician may say he/she will call with lab results for the patient and then doesn’t. These actions create frustration between patients and their physicians. If they then experience an unexpected outcome, the willingness to file a claim is already high.

A medical malpractice suit may arise when the patient or the patient’s family believes “something is not right” with the medical care provided. A study conducted by Gerald B. Hickson and others identified self-reported reasons that prompted families to file malpractice claims following perinatal injuries. These factors include: advised by knowledgeable acquaintances (33% of respondents), recognized cover-up (24%), needed money (24%), recognized that their child would have no future (23%), needed information (20%), and decided to seek revenge or protect others from harm (19%). Families believed that physicians would not listen (13%), would not talk openly (32%), attempted to mislead them (48%), or did not warn about long-term neurodevelopmental problems (70%).[i]

In another study, Charles Vincent and others examined the reasons patients and their relatives take legal action. Over 70% of respondents were seriously affected by incidents that gave rise to litigation with long term effects on work, social life, and family relationships. Patients’ decisions to take legal action were determined not only by the original injury, but also by insensitive handling and poor communication after the original incident. This study found that patients taking legal action wanted greater honesty, an appreciation of the severity of the trauma they had suffered, and assurances that lessons had been learned from their experiences.  Many fundamental issues will not be addressed or resolved if litigation is viewed solely as a legal and financial problem.[ii]

As mentioned previously, lawsuits have little to do with physical harm to the patient and much to do with the relationship between the physician and patient. Patients who sue often feel abandoned by their doctors. Doctors can most effectively communicate with patients by listening carefully, ask open-ended questions, do not interrupt, make eye contact and indicate that they care. The physician’s competency is, of course, important and patients will stay with doctors they feel are cold or uncommunicative in the belief that a physician’s technical and diagnostic skills are more important than beside manner. Competence and communication are equally important in the patient-physician relationship.

To reduce the risk of being sued, a physician should incorporate a risk-management style in their practice.  This includes being: 

• Compassionate - show the patient that you sincerely are concerned about his/her concerns/complaints
• Competent – a competent physician knows when to seek consultation, for example, when the patient isn’t getting better as quickly as expected or when the patient’s presentation is atypical or the diagnosis obscure
• Communication – is essential between patient and physician, but it is equally as critical between other members of the health care team (i.e., nurses and consultants
• Charting – good charting is your best defense. Chart as though the patient will read it and ensure that it is accurate and legible.

No one can guarantee immunity from lawsuits. However, developing excellent relationships with patients, promoting open communication with patients, colleagues and other members of the health care team, maintaining clinical competence and charting accurately and legibly can go a long way toward reducing liability risk.