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The doctor-patient relationship and malpractice. Lessons from plaintiff depositions
H B Beckman1, K M Markakis, A L Suchman
1Department of Medicine, Highland Hospital, Rochester, NY 14620.
Archives of Internal Medicine
|June 27, 1994
Summary
Patients sue doctors due to perceived lack of care and poor communication, not just adverse outcomes. Understanding patient perspectives and improving provider-patient relationships are crucial to reduce malpractice claims.
Area of Science:
- Medical Malpractice Law
- Patient-Provider Communication
- Healthcare Quality Improvement
Background:
- Limited understanding exists regarding the specific factors motivating patients to file malpractice lawsuits.
- Existing literature fails to explain why not all adverse medical outcomes lead to litigation.
- A methodological gap hindered direct inquiry into plaintiffs' experiences and motivations.
Purpose of the Study:
- To investigate the underlying reasons and contributing factors prompting patients to initiate malpractice claims.
- To explore the role of patient-provider relationships and communication in the decision to litigate.
- To analyze plaintiff deposition transcripts for insights into the drivers of malpractice litigation.
Main Methods:
- A descriptive series review of 45 randomly selected plaintiff deposition transcripts from settled malpractice suits.
- Data extraction focused on alleged injuries, reasons for suing, problematic relationship issues, and suggestions of maloccurrence by health professionals.
- Consensual validation was used to categorize relationship issues, and answers to key questions were analyzed.
Main Results:
- Problematic relationship issues were present in 71% of depositions, with high interrater reliability (93.3%).
- Key themes included perceived patient abandonment (32%), devalued patient/family input (29%), poor information delivery (26%), and lack of understanding (13%).
- Over half (54%) of plaintiffs reported that a health professional suggested maloccurrence, often a post-event consultant.
Conclusions:
- The decision to litigate is frequently linked to a perceived deficit in healthcare empathy and collaboration.
- Identified issues encompass perceived provider unavailability, dismissal of patient concerns, inadequate communication, and failure to understand patient perspectives.
- The interaction between patients and post-adverse-event consultants warrants specific attention.
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