Communication gaffes: a root cause of malpractice claims

Beth Huntington, BSN, MSN, JD, and Nettie Kuhn, RN, BSPA, CPHRM

From the Office of Risk Management, Baylor Health Care System.

Corresponding author: Beth Huntington, Office of Risk Management, Baylor Health Care System, 2001 Bryan Street, Suite 2800, Dallas, Texas 75201 (e-mail: bethhu@BaylorHealth.edu).

We are presently in the throes of another medical malpractice insurance crisis, not unlike the crisis that occurred in the late 1970s. The availability of medical malpractice insurance is diminishing; insurance premiums are skyrocketing; insurance carriers are going bankrupt or refusing to write insurance in Texas. In some areas, the cost of malpractice insurance is prohibitive, causing physicians to leave medicine. The most concerning fallout is that patient access to care is being compromised.

It is easy to blame insurance companies, plaintiff lawyers, and runaway juries for our woes. It is harder to examine our own practices and ask ourselves what we could do to change patients' feelings that they need to sue doctors, hospitals, and nurses. In this age of phenomenal technological innovations and highly successful treatments and cures, why is it that our customers, the patients, are dissatisfied with their health care to such a degree that they feel compelled to file a lawsuit?

Do physicians have influence over the circumstances that cause patients to file lawsuits? While physicians cannot control all the stated reasons for patients' seeking legal redress, they are able to influence the quality of their relationships with patients. And the foundation for a good patient-physician relationship is communication. This article discusses the “art” of communication as it occurs in everyday patient encounters, the important dialogue that occurs when giving informed consent, the challenge of encountering an angry patient, and the new trend of disclosing unexpected outcomes and medical errors.