Reducing litigation costs through better patient communication.
Specifically, patients complain when the doctor does not listen or attempts to mislead mis·lead
tr.v. mis·led , mis·lead·ing, mis·leads
1. To lead in the wrong direction.
2. To lead into error of thought or action, especially by intentionally deceiving. See Synonyms at deceive. them. According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. the Harvard Medical Practice study, less than three percent of patients who experienced severe adverse events brought forth a malpractice claim. (1)
It is ironic that clinicians who fail to disclose mistakes based on fear of being sued are by nondisclosure increasing the probability of a lawsuit by nine-fold. Communicate and you save time and decrease the risk of litigation An action brought in court to enforce a particular right. The act or process of bringing a lawsuit in and of itself; a judicial contest; any dispute.
When a person begins a civil lawsuit, the person enters into a process called litigation. .
In 2005, American medical school graduates will have to pass a national test for communication and clinical skills before they can obtain a license to practice medicine. The $975 test sponsored by the National Board of Medical Examiners A public official charged with investigating all sudden, suspicious, unexplained, or unnatural deaths within the area of his or her appointed jurisdiction. A medical examiner differs from a Coroner in that a medical examiner is a physician. and the Federation of State Medical Boards Federation of State Medical Boards,
n.pr an association comprising the medical boards of the United States, the District of Columbia, the Virgin Islands, Guam, Puerto Rico, and 13 state boards associated with osteopathic medicine. , will evaluate how well physicians communicate and interview patients and perform basic assessment procedures. It has been suggested that older physicians also take such an exam to improve the quality of care and reduce malpractice cases.
The principal affliction of the medical community is thinking that physicians cannot improve communications substantially. Communication is the first test of clinician clinician /cli·ni·cian/ (kli-nish´in) an expert clinical physician and teacher.
n. competence. America stopped giving this exam in 1964. To reinstate To restore to a condition that has terminated or been lost; to reestablish.
To reinstate a case, for example, means to restore it to the same position it had before dismissal. the exam is a return to old-school values of communication.
According to the Medical Council of Canada, 2.4 percent of their medical students fail this exam and are ineligible to practice. Students can retake re·take
tr.v. re·took , re·tak·en , re·tak·ing, re·takes
1. To take back or again.
2. To recapture.
3. To photograph, film, or record again.
1. the exam up to three times per year. The seven-hour test consists of patient encounters in which the clinician demonstrates the ability to take a medical history, perform physical exams and communicate effectively with volunteers who have been trained to portray real life scenarios.
4 ways to improve communication
1. Focus on the issues
Building on the work of Erik Erikson For the choral conductor, see .
Erik Homburger Erikson (June 15, 1902 – May 12, 1994) was a German developmental psychologist and psychoanalyst known for his theory on social development of human beings, and for coining the phrase identity crisis. at Harvard, a well-designed communications plan should have the four E's: Empathy, Engagement, Education, and Enlistment. (2)
Doctors should first exhibit empathy by meeting patients in the waiting room or exam room before the patients undress. In the exam room listen to the patient, look them in the eye, share the back-story, then affirm them by using the patient's own words to summarize.
Use open-ended questions A closed-ended question is a form of question, which normally can be answered with a simple "yes/no" dichotomous question, a specific simple piece of information, or a selection from multiple choices (multiple-choice question), if one excludes such non-answer responses as dodging a and never interrupt the patient for the first minute. The average clinician interrupts the patient after only 18 seconds. (3)
Engagement sets the groundwork for a partnership between provider and patient. Ask the patient about family and work, and restate major points utilizing the person's language while minimizing technical jargon.
2. Educate the patient
Typical physicians who think they provided six minutes of patient education actually only provided 40 seconds when we play back the videotapes. Most of the 40 seconds is jargon. The majority of patients have zero understanding of the message.
To really educate, one has to probe gently to discover the patient's concerns and fears. For example, the patient might fear the side effects Side effects
Effects of a proposed project on other parts of the firm. , or they might fear the cost of the prescription. In some areas, patients do not fill 30-40 percent of prescriptions for economic reasons.
Doctors must be clear in defining or describing terms, then ask if the patient understands. Be patient-centric, and consider what the patient is thinking: What has happened to me? When will I have the results? Why has this occurred? What will be done? Will it hurt? Why are they recommending this treatment alternative?
3. Enlist the patient
The doctor should enlist the patient as a collaborative team member in the decision-making process. Patient compliance improves if the patient is brought into the inner circle of designing the treatment plan. Technical facts are of little value if the clinician is viewed as cold or distant--unconcerned with the patient's routines, habits and lifestyle.
As part of the team approach, the clinician should suggest a treatment plan then ask how it fits with what the patient has been thinking. No education or enlistment has occurred unless the patient has questioned prior preconceptions and learned something for the future. Always close a patient visit by reviewing the treatment plan and schedule for future visits. Try to enhance follow-up concerns by telephone or e-mail.
Enhanced patient communication can be cost-effective if patient satisfaction and compliance are improved and if the length of visit is extended only one or two minutes. The patient also is concerned with time management issues, which is why e-mail visits and health education chat rooms can improve both net revenues and patient satisfaction.
The economic efficiencies of workplace redesign and staff training can enable the clinician to spend more quality time with patients. Always consider the four E's: Empathy (that must have been difficult), Engagement (what do you think is causing your problem?), Education (do you understand what we must do together to enhance your health?), and Enlistment (what support can the team give you in handling the treatment plan we designed?).
4. Shared decisions and mutual trust
A number of federal studies suggest that the quality of the doctor-patient relationship doctor-patient relationship,
n in-teraction between a physician and a patient. has eroded, even for the doctor's long-time patients. (4, 5) Ineffective communication reduces the accuracy of the diagnosis and the utility of the treatment plan.
We need to overcome cultural barriers to communication. You do not want your patients to say: he shows no concern, no warmth, would not answer questions, could not listen. The traditional doctor gathers the facts, but the clinician must also discover the patient's own perception regarding their health and lifestyle habits.
Patients weigh their own internal calculus calculus, branch of mathematics that studies continuously changing quantities. The calculus is characterized by the use of infinite processes, involving passage to a limit—the notion of tending toward, or approaching, an ultimate value. for the benefits of the treatment plan against the costs in side effects and curtailed pleasurable habits. Communicating collaboratively, and making the patient a member of the care team, can bend the patients' calculus to see the costs, risks and benefits of the treatment plan.
Periodic training sessions for the clinician and staff will help to keep people skills honed and patient-centric. The professional culture of medicine is changing, high-touch is back, and primary care values of collaboration are ascending. Embrace the change, or get run over and lose your patients.
All the software and machines in the world cannot displace the good communicator. Value creation in the minds of the public is returning to continuity of care and primary care values.
For the three decades I have worked with the Institute of Medicine, we have always called for a sustained partnership with patients based on mutual trust. With better communication comes more effective screening, prevention and health education. Better communication improves both clinician satisfaction and patient satisfaction. The result is good economics and good medicine.
1. Kohn and LT, Corrigan JM, Donaldson, MS, eds. To Err Is Human "To Err is Human: Building a Safer Health System" is a groundbreaking report issued in 2000 by the U.S. Institute of Medicine which resulted in an increased awareness of U.S. medical errors. The push for patient safety that followed its release currently continues. : Building a safer health system. Washington, DC: National Academy Press, Institute of Medicine Committee on Quality of Health Care in America, 2000.
2. Erikson E, A New Way of Looking at Things, New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Norton, 1987.
3. Eastaugh, S., Health Care Finance and Economics, Sudbury, Mass.: Jones and Bartlett, 2003. www.jbpub.com
4. Safran D, "Defining the future of care: what can we learn from patients?", Annals of Internal Medicine Annals of Internal Medicine (Ann Intern Med) is an academic medical journal published by the American College of Physicians (ACP). It publishes research articles and reviews in the area of internal medicine. Its current editor is Harold C. Sox. , Feb. 4, 2003, 138 (3):248-255.
5. Eastaugh S, "CQI CQI Continuous Quality Improvement
CQI Chartered Quality Institute (UK)
CQI Clinical Quality Improvement
CQI Channel Quality Indicator
CQI Constant Quality Improvement
CQI Canonical Query Language
CQI Cost of Quality Improvement and planning," Academic Medicine, November 1999, 70(6): 465-470.
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The most common cause of malpractice suits is failed communication with the patients and their families. Explore ways that better communication could lead to fewer malpractice claims and allow health care organizations to reduce litigation costs.
By Steven R. Eastaugh, PhD
Steven R. Eastaugh, PhD, is a professor, School of Public Health and Health Services health services Managed care The benefits covered under a health contract , Department of Health Services Department of Health Services may refer to: