This is the most important factor IMHO
And what research there is in this area supports that.
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Angered patients and the medical profession.: [FONT=Arial, Helvetica]
Changing from "doctor's orders" to "patient's choice".
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MJA 1999; 170: 576-577[/SIZE]
Despite evidence to the contrary from the Harvard Medical Practice Study, the belief remains prevalent that most litigation results from gross errors in medical diagnosis and treatment, and that these are best minimised through clinical quality control. While clinical errors are usually involved, the
likely precipitant is more likely to be a communication error. It is not sufficient for a doctor to reach a conclusion regarding diagnosis and optimal treatment. This must be conveyed to the patient and then skill exercised to motivate the patient to adopt that same point of view. The patient is the one with the problem and it is for the patient to decide, on the basis of the information provided, whether or not to take the doctor's advice. It is no longer "doctor's orders", it is "patient's choice". Furthermore, "informed refusal" is as important as "informed consent". How much non-compliance is
uninformed refusal?
The results of the Harvard Medical Practice Study (HMPS)[SIZE=-1]
3 [/SIZE]not only suggested that
if you are sued you are unlikely to have been negligent, but also that if you are negligent you are unlikely to have been sued! In about 300 of the 30 000 New York hospital records reviewed, it was assessed that an adverse outcome had resulted from avoidable negligence -- but in only about one in eight of these had a claim for compensation been made. Conversely, of all the legal actions commenced against the surveyed hospitals in that period, only about a third involved one of those 300-odd files.
Two conclusions can be inferred from the HMPS. Firstly, that
other intervening factors, such as communication failures in the doctor-patient relationship, determine whether or not an adverse event will result in litigation, and, secondly, that a negligent act or omission is a necessary, but not the sole, condition for a successful claim in negligence. A third possible conclusion, of course, is that patients do not sue when they have no inkling that their adverse outcome arose from a negligent error! The Bristol case[SIZE=-1]
4[/SIZE] shows that, even when a negligent error is reported, instead of facilitating communication the first response of the medical community may be to suppress the information by "killing the messenger".
The
factors driving a patient to sue were surveyed in a 1994 study in the United Kingdom of 227 patients who had commenced legal action for alleged medical negligence.[SIZE=-1]
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Only about a quarter said their primary motive was money (compensation). The rest were evenly spread between "it was the only way we could find out what really happened" (information/communication), "we wanted someone brought to account for what happened" (acknowledgement/accountability) and "we want to ensure this doesn't happen again" (regulation/discipline). Litigation(seeking compensation through a civil action) can only provide money, and a poultice of money does not cure all ills.
A doctor's behaviour after an adverse event, or after receipt of a complaint, is often the major factor determining whether the patient proceeds to litigation or chooses another avenue of complaint or does nothing.
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