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Be a better communicator: How patient-centered communication can reduce medical malpractice risk

Listen up physicians: Don't want to take the time to communicate effectively with your patients? It may cost you.

If the evidence that improved communication leads to improved patient satisfaction doesn't convince you, then maybe the idea of reduced medical malpractice risk will convince you.

The same goes for patients. Not taking the time to effectively communicate with your physician can lead to misunderstanding, frustration and perhaps an improper course of treatment.

Risk managers and insurance brokers who represent physicians and consult on ways to reduce medical professional liability have known for years that improved physician/patient communication results in fewer medical malpractice claims. And while medical schools are beginning to teach patient-focused communication skills, this focus is not being adopted widely by practicing physicians.

Many physicians have not had training on patient-focused communication. Many claim to not have the time or resources. Consequently, risk managers who work to protect against medical malpractice claims see a high percentage of cases where physicians and patients don't agree on the diagnosis and consequently the treatment recommended.

A report published in The Oncologist in 2000 underscored the lack of training for physician/patient communication. Specifically,

* Only 4 percent to 5 percent of those surveyed in 1998 had received training in breaking bad news, yet as many as 66 percent indicated they break bad news to patients between five and 20 times per month.

* 74 percent indicated they didn't have a specific approach planned for breaking bad news.

Many malpractice suits are due to patient frustration with faulty communication, not competency. So doctors who claim they don't have the skills, time or resources to communicate effectively need find them. The physician's investment on the front end of this patient interaction may save time and money on the back end by averting patient dissatisfaction or potential medical malpractice claims.

What does good physician/patient communication look like?

* Before the exam begins, the physician explains what is going to be discussed and done, and why.

* The physician recognizes that every patient is unique and engages them in small talk while watching for nonverbal cues of anxiety and emotion.

* The physician solicits a health overview from the patient.

* The physician listens more than speaks.

* The physician has taken the time to evaluate his or her informed consent communication pieces and methods, making sure they are understandable and up to date. Some may have implemented alternative media like a DVD, or a computerized Q&A program to facilitate better understanding.

* The patient feels like they have been listened to and their questions have been answered.

Critical to the success of the exam is determining if anything needs to be clarified before the patient leaves. And, perhaps more importantly, reiterating what the patient said and asking what the patient heard.

Physicians may comment that the hardest part of their clinical practice involves the necessary one-on one-communication required with patients. Why is this the hardest? Because this is the part of their practice in which they received the least training.

In recognizing that not all physicians are compassionate, easy-to-understand communicators, the good news is that communication skills can be studied and learned and practiced and improved on the job. The physician needs to select the skill set that is the most comfortable for them, personalize it and practice it.

Following these suggestions will go a long way toward reducing medical malpractice risk, increasing job satisfaction and improving patients' outcome.


Submitted by Bill Buchanan, principal and Healthcare Practice division leader of Barney & Barney LLC

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