Improving communication, cutting risk
Why is effective communication with patients and colleagues so essential to managing risk for doctors? Dr Jagdeesh Singh Dhaliwal, MPS Manager and Senior Medical Educator for the Asia-Pacific region, offers some thoughts
Casebook readers who have never attended any of our risk management workshops and master classes might ask themselves why MPS’s educational programmes focus so heavily on communication.
As doctors, we spend our professional lives seeking to finesse our clinical knowledge and our clinical skills. Fear of becoming “an out-of-date doctor”, coupled with a desire for excellence, probably sums up the strong psychological drivers for study and improvement shared by most members of our profession.
Fear of becoming “an out-of-date doctor”, coupled with a desire for excellence, probably sums up the strong psychological drivers for study
Thinking back to our experiences at medical school, many of us will no doubt remember how difficult it felt to be able to converse with patients and elicit a complete history during the early clinical years.
However, we persist and follow through and as our knowledge and practical skills grow, so does our history-taking ability – and we start to become competent and confident as diagnosticians.
It can be a rude shock, therefore, to find oneself in a situation where a patient is unhappy despite an objectively correct diagnosis and an excellently executed surgical or medical management plan.
“Why are they unhappy with me, when I did everything correctly?” “How dare they complain…” “I would understand if I had done something wrong… but a complaint when I did everything right is very unfair…”
A negative spiral can ensue where we either get angry at the patient and the family or sad or upset about the unfairness of a complaint that was not the result of a clinical mistake.
MPS’s claims data and international research consistently demonstrates the following: it is patient dissatisfaction with communication by their doctor that fuels the majority of complaints.
Recently, for example, Moore et al’s1 study into hospital complaints in Chile has demonstrated that patient dissatisfaction with communication with the doctor is the largest contributing factor leading to a complaint. From the other end of the globe, Hamasaki et al2 have explored the increasing trend of doctors’ explanations forming a pivotal point of medical malpractice litigation by patients in Japan. These studies build on earlier research from around the world, which emphasises the role of problematic communication as a key reason patients decide to sue following an adverse outcome.3,4,5,6
And specifically, it is a failure on the part of doctors to communicate caring that lies at the heart of most patient dissatisfaction with their doctors.
It is a failure on the part of doctors to communicate caring that lies at the heart of most patient dissatisfaction with their doctors
For instance, Ambady et al’s7 interesting study found that (controlling for content), surgeons’ audiotaped voices that were independently assessed by two patients as demonstrating “high dominance over the patient” and “low concern/anxiety for the patient” correlated significantly with those surgeons who had previous claims. Beckman et al’s8 seminal paper looking at plaintiff depositions demonstrated an association between “perceived lack of caring and or collaboration” and patients’ decisions to litigate against their doctor. Chiu et al9 in Taiwan have found that a driving motivation for patients and their families for litigating is the emotional desire to achieve comfort or, in other words, a sense of “being cared for”.
Certainly, it seems, the research would point to poor communication and a lack of caring being instrumental in patients’ decisions to sue.
But is the converse true? Is being a good communicator and demonstrating caring associated with less risk of sustaining patient complaints?
Amongst other studies, Moore et al10 have found that positive doctor communication behaviours increase patients’ perceptions of the competence of that doctor and decreases their intention to sue either the doctor or his or her hospital in the event of an adverse outcome. And a very interesting study by Hagihara et al11 has found that physician explanatory behaviours, including explaining and listening to families, is associated with a markedly lower probability of a court decision of negligent care by judges in Japan.
What might this mean for us as doctors? Perhaps this.
That, as well as continuously perfecting our technical expertise in our particular specialty, continuously perfecting our communication and empathy skills is essential to cutting our risk. It is this combination of both technical and emotional performance that appears to single out the route to ongoing overall excellence as a doctor.