January 2003
Why people sue
by Timothy J. Feuling
There is a justifiable perception that patients sue their
doctors because of errors or negligence. After all, the number of people
injured and killed each year by iatrogenic disease is staggering.
Newspapers are filled with reports of doctors amputating the wrong limbs,
giving accidental overdoses, leaving sponges inside surgical patients and
going on hospital rounds while half asleep from overwork. Even the best,
most careful medical doctors dispense drugs and perform procedures which
all have the potential for negative side effects or adverse
"events."
But what of doctors of chiropractic, who are considered the
safest of all health care professionals? They don't prescribe drugs or
perform surgery and they normally do not subject their patients to any
product or procedure that carries with it any real risk of harm. Why,
then, are D.C.s sued for malpractice?
Research has shown that only one in six malpractice claims
actually involved negligence. The other five out of six are spurred by
something other than the quality of clinical care.
In its Fall 2000 issue, the Journal of Law, Medicine &
Ethics concluded that the main reason people sue their doctors is
because of faulty or inadequate communication. In study after study,
researchers have found that one of the major complaints made by plaintiffs
is that their doctors didn't listen to them or didn't explain fully the
procedures or treatment they were providing.
One study, published in the Journal of the American
Medical Association, compared the communication behavior of physicians
with two or more malpractice claims with that of doctors who had never
been sued. The lawsuit‑free doctors tended to spend more time with
patients, explain things more frequently during the visit, and use humor
and laughter when appropriate.
The Risk Management Foundation of the Harvard Medical
Institutions confirms this conclusion when it states, "In addition to
being essential to practicing good medicine, a strong professional
relationship with your patients is your most effective shield against
malpractice claims."
This doesn't mean that you need to spend half an hour
chatting with each patient or trying to become "friends" with
them all. Nor does it mean forcing an unnatural enthusiasm if you happen
to be a more low‑key type of person. However, there are several
steps you can take to improve your communication skills, and reduce your
risk of malpractice complaints.
1. Make sure each patient is properly and completed educated
in practice and purpose of chiropractic. This can be done during a patient
"classroom" event or by a trained C.A. Making sure patients have
patient education material, such as a copy of "Chiropractic
First," can help the process. Avoid jargon but don't
over‑simplify. Don't be afraid to use the term "vertebral
subluxation," but make sure you explain it in layperson's terms.
2. When with your patient, give him or her your full,
undivided attention. Don't adjust a patient while talking with your
C.A.
or yakking on the phone.
Even if the patient visit only lasts a few minutes, by focusing on that
patient, you are sending a clear message that he or she is important to
you.
3. Be aware of your nonverbal communication. Trying to
explain subluxations while towering over someone lying on your adjusting
table can be disconcerting for the patient. Speaking to patients "eye
to eye," is the most comfortable and helps establish a good rapport.
In addition, realize that although you might have given the same patient
education talk many times, it can be new and confusing to patients. Don't
signal your own impatience by sighing, glancing at the clock or shaking
your head.
4. Apologize if you are late for an appointment, or if there
was any other problem associated with the patient's visit. Too often, a
doctor's perceived "arrogance" stirs the ill‑feelings
which lead to malpractice suits.
5. Train your
C.A.
and office staff to
likewise pay attention to patients and show them respect. Trying to pay
for a visit or set up another appointment while staff members chat among
themselves about their weekend plans can make a patient feel slighted.
6. Don't ignore or become angered by patient complaints
‑‑ listen to them and learn from them. While criticism about a
"rude
C.A.
" may seem
unjustified, remember that only a small percentage of people will actually
lodge a complaint. If one person speaks up, it's possible that others have
had the same reaction but said nothing. Take time to resolve all
complaints at the time they are presented. "A few extra minutes to
diffuse a complaint before it escalates are well spent," emphasizes
the Risk Management Foundation.
By recognizing the importance of good communication and
rapport with your patients, you will not only build a larger practice, but
you'll help safeguard it against malpractice suits.
Sources
"A survey of physician training programs in risk
management and communication skills for malpractice prevention," by
Frank V. Lefevre, Journal of Law, Medicine & Ethics, Fall 2000.
"Relation Between Malpractice Claims and Adverse Events
Due to Negligence: Results of the Harvard Medical Practice Study
III."
New England
Journal of Medicine,
325 (1991).
"Physician‑Patient Communication: The Relationship
with Malpractice Claims Among Primary Care Physicians and Surgeons,"
W. Levinson et al., Journal of the American Medical Association,
277 (1977).
(Timothy J. Feuling is president of Chiropractic Benefit
Services (CBS) and vice president of the World Chiropractic
Alliance
. He assists doctors
in maximizing their practices through the proper choice of insurance and
related services. Doctors may contact him with questions, comments, and
requests for insurance quotes at
2950 N. Dobson Rd. Ste. 1
,
Chandler
,
AZ
85224
, by phone at
800-883-0412 or by e-mail: feuling@cbsmalpractice.com).
