In an increasingly litigious World where blaming and complaining does seem increasingly common, it seems doctors are under increasing pressure to ‘practice defensively’. This means not necessarily giving the best care, but the care influenced by a desire to avoid complain or litigation. I found a good description of defensive medicine that goes like this: Defensive medicine occurs when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their exposure to malpractice liability. When physicians do extra tests or procedures primarily to reduce malpractice liability, they are practicing positive defensive medicine. When they avoid certain patients or procedures, they are practicing negative defensive medicine.
Personally, I think it’s a shame that fear can drive healthcare decision-making, but I also know this issue is unlikely to go away anytime soon. However, I do think it’s worth remembering that complaints and litigation can be really rooted in another problem altogether: a failure of good communication between a doctor and their patient. Anecdotally, I have known quite a few people who have made complaints, and it’s a common occurrence to hear them cite their doctor’s attitude (rude/dismissive/pompous/condescending/whatever) as a factor in their decision to act.
With this in mind, I was interested to read a study published today in the Journal of the American Medical Association which sought to assess what, if any, relationship there is between a doctor’s ‘bedside manner’ and their chances of having a complaint made against them .
This research was conducted in Canada, where doctor-patient communication skills testing was introduced as part of the medical credentialing process in the 1990’s. Of the retained (non-dismissed) complaints, almost 82 per cent were found to be due to attitude/communication or quality-of-care issues. Those doctors with low ‘communication scores’ were significantly more likely to have a complaint made against them that was retained. The lead author of this study, Dr Robyn Tamblyn is quoted as saying that: “We need to have physicians who can communicate better, and we should select not just on the basis of IQ, but of emotional IQ.” Hear, hear to that.
One useful skill I think worth fostering as a doctor (and as a human being too) is the ability to empathise. Let’s be frank, most individuals don’t want to visit their doctor, and usually have no conscious desire to be ill either. It’s not difficult to imagine how an abrasive, off-hand or dismissive manner may not be tolerated in such circumstances.
My experience is that the communication and ‘attitudinal’ problems between doctors and patients stem from an intellectual superiority that we doctors can be prone to wielding. Yet, however much we think we know, we can never really know what it’s like being the person who is asking for our help and advice. Whatever symptoms they come with may be accompanied by all manner or fears and anxieties.
Extending a listening ear and offering some genuine care (not necessarily health care, just care) are to me at least as important as any medical or scientific know-how we doctors have. Not only may this help keep complaint rates down, but it might actually help individuals feel better too. And I don’t just mean on an emotional level: it should not be forgotten that a sympathetic and caring manner may do much to harness the power of the placebo response.
1. Tamblyn R, et al. Physician Scores on a National Clinical Skills Examination as Predictors of Complaints to Medical Regulatory Authorities. JAMA. 2007;298:993-1001.