This study was a qualitative retrospective assessment of depositions and indicated that the decision to litigate was often associated with a perceived lack of caring and/or collaboration in the delivery of healthcare. Problematic relationship issues between the doctor and patient were identified in 71% of the depositions. These could be categorized by four themes: deserting the patient (32%), devaluing patient and/or family views (29%), delivering information poorly (26%), and failing to understand the patient and/or family perspective (13%). The postoutcome consulting specialist was named in 71% of the depositions in which malpractice was alleged. These results imply that if more attention had been focused on the physician/patient interaction, particularly at the postoutcome consultation, litigation could have been avoided in many of these cases. this
The importance of the physician/patient relationship in determining patient willingness to sue has also been demonstrated in other studies. A report by the American College of Obstetrics and Gynecology based on 59 primary care physicians examined patient consultations for physicians who had never been named in a malpractice claim vs those with two or more claims against them. In a multivariate analysis, “no-claims” physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, used more facilitation (soliciting patients’ opinions, checking understanding, and encouraging patients to talk), and spent longer times in routine visits (mean, 18.3 min vs 15.0 min; difference not significant) compared with physicians who had been named in claims. Therefore, routine physician/patient communication was different between doctors without claims vs those that had been sued for malpractice. Thus, with regard to malpractice avoidance, communicating effectively with patients may be a physician’s best defense.
Patient-focused care may have a particular role to play in the management of difficult-to-treat patients. These patients may have more complex needs because of their disease severity and/or social and economic factors. Evaluating these more complex needs and meeting them may require specialist services and training. However, it also requires the development of long and positive relationships between clients and service providers.