SOURCE: AAP News
As experts in prevention, pediatricians need to know essential strategies to prevent medical liability claims. Ample research shows that communicating skillfully and fostering effective physician-patient relationships can help pediatricians avoid malpractice litigation. The literature also provides insights on how pediatricians can enhance communication skills.
Communication differences between physicians and surgeons with malpractice histories and those with none are revealing. A sentinel study found that primary care physicians with no malpractice claims employed the following communication techniques: oriented patients about what the visit would entail, solicited opinions and concerns, verified patient understanding, and spent more time during office visits. No such differences were identified among surgeons with malpractice claims and those without (Levinson W, et al. JAMA.1997;277:553-559).
A recent analysis of 24,000 medical liability claims from 2009-’13 by CRICO, a program that insures Harvard medical institutions and their affiliates, revealed that communication failures were factors in 30% of malpractice suits. More than half of those cases resulted from communication problems between providers and patients/families.
Another study found that one-third of malpractice litigation was related to communication problems manifested by the physician appearing inattentive, discourteous or providing inadequate information (Roter D. J Health Care Law Policy. 2006;9:304-314).
Research shows a positive rapport with patients, largely based on quality communication, influences whether a patient will file a malpractice claim. An analysis of malpractice depositions of patients (i.e., plaintiffs) revealed that 70% of decisions to sue were based on problems with the physician-patient relationship. Plaintiffs described the defendant doctors as communicating poorly, being unavailable and lacking appreciation of patients’ views (Beckman HD, et al. Arch Intern Med. 1994;154:1365-1370).
Similarly, dissatisfaction with provider-family communication was one of several reasons given by parents of infants with perinatal injuries for filing a malpractice claim. Sources of dissatisfaction with physician communication included inadequate listening, lack of transparency, misleading statements and not warning the parents of potential long-term problems (Hickson GB, et al. JAMA. 1992;267:1359-1363).
Forging a strong physician-patient relationship is more important than ever. Parents can access online information about a physician’s credentials and reputation before making appointments. All that being equal, they often select clinicians based on how well they communicate and build a physician-patient partnership during initial medical encounters. Such traits are associated with quality of care and can serve as buffers from medical liability actions. Patients tend not to file lawsuits against physicians they trust and regard positively even when they have experienced adverse events (Huntington B, Kuhn N. Proc (Bayl Univ Med Cent). 2003;16:157-161).
While establishing relationships is a two-way street, the courts place the ultimate responsibility on the physician to “initiate, clarify, facilitate, document and reinforce discussions about their patient’s condition, treatment and prognosis” (Byington M, Bender A. Harvard Risk Management Foundation Forum. 2000;20:1-5).
However, lack of time, patient volume expectations, excessive documentation requirements and administrative burdens can interfere with effective communication and distract from building trust and mutual respect with parents. These challenges should motivate physicians to become more skillful communicators in order to achieve efficiencies and deliver quality, patient-centered care in constrained time frames. Self-awareness, self-monitoring and ongoing training are meaningful ways to do this.
Pediatricians should not assume their skills are top-notch just because they’ve been communicating with parents and patients for years. They can improve by paying attention to nonverbal communication cues during patient interactions; avoiding interruptions; listening carefully; and participating in continuing medical education workshops on communicating with patients.
Risk management pointers on patient communication
- Employ a patient-centered approach. Solicit and respond to the patient’s/parents’ ideas, concerns and expectations.
- Use language the family can understand, taking into account health literacy, limited English proficiency and culture.
- Personalize the information rather than giving it as a rote speech (e.g., use the child’s name and customize it to the situation).
- Develop a partnership with the patient/parents.
- Establish or review the patient’s/parents’ preferences for information.
- Present information and help decision-makers reflect on the impact of various treatment options, taking into account their lifestyle and values.
- Agree on an action plan and complete arrangements for follow-up.
- Ask parents and the child (when appropriate) to repeat what they understood in their own words, and clarify information and plans as needed.
- Document the agreement, actions taken and any follow-up actions.
Being the best communicator you can be will benefit you and your patients in the exam room and may keep you out of the courtroom.
Dr. Scott is a member of the AAP Committee on Medical Liability and Risk Management.