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Is disclosure the best defense?

Discussion in 'Pre-Medical - MD' started by Mr. Z, Apr 24, 2002.

  1. Mr. Z

    Mr. Z Senior Member 7+ Year Member

    Apr 19, 2002
    For all you doctors to be, this is an issue we all need to think about as we enter into the medical profession...

    An excerpt from Annals of Internal Medicine. Vol 131, Number 12.

    Why do patients sue? Bad outcomes and errors in care are obvious factors, but some of the available evidence implicates deficient communication. One attorne explained it to me this way: "In over 25 years of representing both physicians and patients, it became apparent that a large percentage of patient dissatisfaction was generated by physician attitude and denial, rather than the negligence itself. In fact, my experience has been that close to half of malpractice cases could have been avoided through disclosure or apology but instead were relegated to litigation. What the majority of patients really wanted was simply an honest explanation of what happened, and if appropriate, an apology. Unfortunately, when they were not only offered neither but were rejected as well, they felt doubly wronged and then sought legal counsel."

    Reviewing his experience as a malpractice defense attorney, Green (1) estimated that although less than 20% of medical malpractice cases involve negligence, almost all involve a breakdown in the physician-patient relationship. Patients often form unrealistic expectations because their physicians fail to discuss treatment alternatives. in a review of closed claims in Florida, Hickson and colleagues (2) found that almost 50% of perinatal injury lawsuits were motivated by suspicion of a cover-up or by the desire for revenge. Levinson and coworkers (3) found that primary care physicians were less likely to be sued if they told the patients what to expect, encouraged them to talk, used humor, and spent more time talking with them. An estimated 75% of all malpractice lawsuits involve inpatient or emergency department care; in these care settings, the physician and the patient usually do not have an established relationship.
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  3. SMW

    SMW Grand Member 7+ Year Member

    Jul 12, 2001
    anchorage, ak
    Welcome to SDN! :D Interesting post, I have no idea why no one's responding. Sounds like disclosure is the best offense! :)
  4. Doctora Foxy

    Doctora Foxy Meow 7+ Year Member

    Jan 28, 2002
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> Levinson and coworkers (3) found that primary care physicians were less likely to be sued if they told the patients what to expect, encouraged them to talk, used humor, and spent more time talking with them. </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I have heard this before. If you're nice to your patients and give them the real deal, you're less likely to be sued. Sounds good to me! Isn't that what it's all about anyway? :) :cool: That's why all you soon-to-be applicants should show compassion in your personal statements and interviews. That's the secret to being a good doctor IMHO. :D

    Welcome to SDN Mr. Z :)
  5. analu

    analu Senior Member 7+ Year Member

    Mar 6, 2002
    Not to be a drag, but I think that what "Levinson and co-workers" found is not 100% fool-proof. First of all, telling the patient what to expect...that's informed consent, required by law, not something M.D.s should try to provide for all their patients. Secondly, in an ideal world, M.D.s would have more than enough time to spend chatting with their patients, but seeing 60 patients plus work-ins makes it hard to spend those precious extra minutes. Finally, it's been my experience (with the doctors I work for) that sometimes, no matter how nice a patient seems, or how well that patient is treated, the litigious nature of some people overrides the best intentions of good doctors and nurses.

    I'm not saying that those findings above are fact, treating people with honesty, dignity, respect, and total candor---I'm all for it. Something we should all aspire to. It's just that to say that MOST malpractice claims are filed because a patient didn't get along with his doctor...that sucks.
  6. TommyGunn04

    TommyGunn04 10+ Year Member

    Mar 7, 2002
    Durham, NC
    Yesterday Patch Adams told us that his clinic has NO malpractice insurance. The reason is that he thinks purchasing such insurance simply establishes a patient/doctor relationship characterized by mistrust. If you expect your patients not to trust you, to ferociously question you, to not be a part of treatment decisions, etc., then you're basically begging them to sue, he says. Interestingly, he and his clinic have NEVER been sued. There's definitely something to this.

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