Your Malpractice Risk: Why Hiring Skilled Staff May Actually Increase It

J.D. Kleinke, former head of research and development at HCIA tells about a study he peer-reviewed for a journal. The researchers found an inverse relationship between a patient's perception of a surgeon's clinical quality and the actual surgical skill. The conclusion: the better your surgeons are at cutting, the worse your patients rate them at the bedside.[1]

And that has a huge impact on your risk. Why?

Because medical errors aren't at the root of your malpractice costs, emotional errors are.

In a survey of research on malpractice risk, researchers collected the reasons patients and families give for suing.[2] Here’s are their suprising results.

Patients sue because they feel deserted, their views were devalued, information was delivered poorly, and their physician didn't understand their perspective.[3] Families said their physicians didn't listen, wouldn't talk openly, tried to mislead them, and didn't warn them about long-term medical problems.[4] Patients wanted more honesty, an appreciation of the severity of the trauma they had suffered, and assurances that staff learned lessons from their experiences.[5]

Paradoxically, hiring staff based solely on their medical skill is likely back-firing.

Your physicians are as aware of the legal environment as you are. If they're like most physicians, in the face of legal risk they take steps they think will keep them from being seen as responsible for bad outcomes.[6] They hold back information (practice non-disclosure) or provide misleading information to patients.[7] Ironically, practicing this kind of defensive medicine encouraged by our current legal environment may actually increase your risk of law suits.[8]

Moreover, it’s not just your most talented surgeons that your patients are unhappy with. The average meeting between a physician and patient includes 7 shared decisions— usually on medication, tests, lifestyle changes, and other treatments. In exit interviews with patients, researchers discovered something startling. In the typical encounter, your patients are unhappy with 2 of the 7 decisions they make with their physician. And in almost 3 of the 7 decisions in an average encounter, patients fail to disclose clinical information relevant to their health, make assumptions without checking their accuracy, and fear the negative judgments of their physicians, and being disrespected.[9] In other words, they have the kinds of experiences that put your medical group at risk.

Perhaps surprisingly, the answer to decreasing medical malpractice costs at the source, inside your medical group, is not to reduce medical errors, but to teach your staff to make their natural compassion more apparent to patients.

[1] See Kleinke’s comments in Satisfying the Impatient Patient, Roundtable Discussion, Healthleaders.com April 2001

[2] Reducing legal risk by practicing patient-centered medicine, Heidi P Forster, Jack Schwartz, Evan DeRenzo. Archives of Internal Medicine. Chicago: Jun 10, 2002. Vol. 162, Iss. 11; pg. 1217, 3 pgs

[3] Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor- patient relationship and malpractice: lessons from plaintiff depositions. Arch Intern Med. 1994;154:1365-1370 [4] Hickson GB, Clayton EW, Githens PB, Sloan FA. Factors that prompted families to file medical malpractice claims following perinatal injuries. JAMA. 1992;267:1359-1363

[5] Vincent C, Young M, Phillips A. Why do people sue doctors? a study of patients and relatives taking legal action. Lancet 1994;343:1609-1613. [6] US Congress, Office of Technology Assessment. Defensive Medicine and Medical Malpractice. Washington, DC: US Government Printing Office; 1994. Publication OTA-H-602. [7] Novack D, Detering R, Arnold R, Furrow L, Ladinsky M, Pezullo J. Physicians' attitudes toward using deception to resolve difficult ethical problems. JAMA. 1989;261:2980-2985. [8] American Medical Association, Special Task Force on Professional Liability and Insurance. Professional Liability in the SOs. Chicago, III: American Medical Association; 1984-1985.

[9] Saba, G. et al. Shared Decision Making and the Experience of Partnership in Primary Care, Annals of Family Medicine 4:54-62 (2006)

Tim Dawes, founder of Interplay, Inc. Check Interplay's website to see how your healthcare organization can exceed your strategic goals by demonstrating unexpected empathy to patients

Tags: honesty, law suits, lifestyle changes, medical errors, medical problems, perception, severity