Doctors sued for uninterest, say researchers in US

BMJ 1994; 309 doi: (Published 03 December 1994) Cite this as: BMJ 1994;309:1461
  1. John Roberts
  1. North American editor, BMJ.

    Doctors who seem hurried and uninterested are at risk of being sued even if they practise good quality medicine, said researchers in the US last week. A team led by researchers from Vanderbilt University in Nashville, Tennessee, examined the malpractice records of obstetricians in Florida during 1987 and found that those who had higher levels of satisfaction among their patients also had lower rates of malpractice claims filed against them.

    The study, published in JAMA, the Journal of the American Medical Association (1994;272:1583-7), was done to find out why more than 85% of lawsuits are filed against 3-6% of doctors. The retrospective study was based on 963 obstetric cases. Researchers reviewed malpractice claims made in one year in Florida, which has a high rate of lawsuits.

    Florida makes public all claims against doctors, whether they become lawsuits or not. They interviewed women who had filed claims and a matched group of women who had not.

    The group classified the 482 doctors into four groups, ranging from those who had frequent but small claims made against them to those who suffered no claims. Doctors who are commonly sued often claim that their patients are more ill than average, but the researchers found that this was not the case among the Florida doctors. Severity of illness was virtually the same among the groups.

    Another explanation for the wide variation in lawsuits is that doctors who practise poorer quality medicine are sued more often. But again the researchers found this not to be the case among the Florida obstetricians. Instead they found that poor communication skills and insensitivity to patients accounted for much of the difference in patterns between doctors sued rarely and those sued frequently.

    “Physicians who had never been sued were more likely to be seen by their patients as concerned, accessible, and willing to communicate,” they conclude. “At the other extreme, physicians who had been sued frequently but for whom relatively little money had been paid in claims were most likely to be seen as hurried, uninterested, and unwilling to listen and answer questions.”

    “These studies show that a doctor might not have done anything technically wrong but generated enough misunderstanding and anger to provoke a malpractice claim,” one of the researchers, Dr Gerald Hickson, told Associated Press.

    In an accompanying editorial Dr Wendy Levinson of the University of Oregon pointed out that malpractice suits are a poor indicator of medical negligence since many claims are begun when no negligence has occurred and only a tiny minority of negligent acts result in litigation.