“Nice” doctors don’t get sued (as often)

Ryan Padgett MD FACEP and Charles Pilcher MD FACEP
June, 2015

“Patient satisfaction scores for your department dropped last quarter. What are your plans to bring them up?” asks a hospital CEO of his ER director.

This question irritates physicians more than the patient with an “emergency” wart at 3 AM.

Press-Ganey, Healthgrades, Leapfrog, US News, RateMD.com and other rating scales have become the bane of hospital based physicians. The delivery of medical care is being reduced to little more than the service provided in restaurants. Just as a waiter can be skewered on Yelp or Urbanspoon for not asking about food allergies or gluten intolerance, physicians can be publicly criticized for lack of bedside manner or any of a host of undesirable traits on these healthcare websites and surveys.

Physicians’ suspicion of the importance of these measures has recently found scientific support. A study in 2012 showed that the most satisfied patients had:

  • a higher rate of hospitalization,
  • greater cost of care,
  • more prescription drug usage and
  • a higher mortality rate.

Thus, more care does not equal better care, so patients need to be careful what they wish for and demand. It may work against them.

But if the thought of being nice to patients to get better ratings makes caregivers bristle, one way to think of it is this: Be nice,  because if the patient likes you, you’re less likely to be sued.

Medical injuries are numerous but lawsuits are relatively few. Patients file malpractice claims for any number of reasons including concern for standard of care, accountability and compensation. But when injured, they are most importantly looking first for an explanation. Yet  only 15% of claimants reported that the explanation was satisfactory. So they sue, so that this won’t happen to someone else.

If physicians can show compassion and improve their ability to explain errors to patients in a way they can understand, lawsuits may decline. Levenson et al. published a study in Health Affairs that supports the need for improvement in the communication skills. She recorded patient interaction between two groups of physicians, ones that had never been sued and ones that had been sued two or more times. Although the amount and quality of information communicated was the same, the physicians who were not sued spent more time with the patient. They also laughed, engaged in active communication and laid out the plan of care.

So how can one be perceived as nice? Dr. Michael Kahn writing in the NEJM suggests some basic, intuitive but frequently overlooked approaches, things as simple as asking permission to enter a room, introducing oneself, shaking hands, sitting down, smiling, showing concern and compassion, asking if all questions have been answered and laying out a plan of treatment. Listening is critical, and physicians should avoid interrupting  patients, educate to their level of understanding and insure buy-in of the plan. With this approach, physicians may achieve the trifecta of good satisfaction scores, increased compliance and lower likelihood of litigation – in other words, safer, higher quality care. “Nice” docs do get sued less often.

But sometimes it’s too late, and a lawsuit has already been filed. What then? For the insurance carrier and the defense attorney, the advice to the physician who find him/herself a defendant is the same: Be nice!

Leave a Comment