Sometimes the Objective of a Research Project Seems to be Ridiculous

Isn't it obvious that a doctor is more likely to be sued for malpractice if that doctor has more complaints from patients lodged against him than other doctors? Isn't it a waste of time and money to perform a research study just to prove this point? Well, one thing investigators have learned is that the obvious isn't always the truth. For example, numerous patients are convinced that difficult physicians have strong convictions and so get into trouble more frequently, but that they are the true pioneers. Such physicians attract this sort of patient who then becomes a faithful adherent, and is willing to suffer the abuse in order to derive the potential benefits.

A group of doctors led by Gerald B. Hickson, M.D. from Vanderbilt University School of Medicine decided to look into the risk factors involved in creating malpractice lawsuits. They published their findings in the June 12, 2002 JAMA under the title "Patient Complaints and Malpractice Risk." The object was to level the playing field by removing those factors, which would be expected to cause an increase such as the specialty in which a physician practices. Evidently certain more risky fields of medicine would be thought to be more prone to creating mishaps. It should therefore be unfair to compare a neurosurgeon to an allergist. When Sloan et al previously investigated malpractice rates among internists, obstetricians, and surgeons they found that 2% to 8% of those in each specialty were responsible for 75% to 85% of their group's award and settlement costs. They also found that the risk for a given doctor didn't tend to vary much with time. On the other hand, studies by other legal and medical investigators have indicated that the traditional reasons for explaining malpractice risk do not tend to be related to characteristics of patients, the complexity of a patient's illness, or even the skill required by the physician. The main factors involved in creating malpractice risk actually tend to be related to the inability of a doctor to communicate with and create a bond with the patient, and to provide access, administer care and treatment that is relevant to the expectations of the patient.

In order to help explain why a small number of doctors tend to be sued more than others Hickson's group decided to examine the association between the number of complaints and the risk management experience of doctors. To do this they set up a retrospective longitudinal cohort study of 645 general and specialist physicians from the same large medical group over a six-year period. Since records were available with proper coding the task was made a good deal easier to accomplish than might have been expected.

Comparing surgeons to nonsurgeons yielded no surprise. Only 32% of nonsurgeons had at least one episode of risk management compared to 63% of surgeons. There was also a direct correlation of complaints and risk management to the number of patients seen. Finally, a significant relationship was found to exist between the total number of patient complaints against a physician and risk management file openings, file openings with expenditures, and lawsuits even when adjustments were made for clinical activity. The authors concluded that doctors compared in a similar surrounding of the same medical group were more likely to experience risk of malpractice if more patients tended to complain about them without being asked.

This study generated some interesting commentary from individuals writing in to JAMA. Doctor Graham observed that some insurers, especially Medicare with secondary companies, tend to take so long before processing claims that patients get their first bill marked as being 90 to 150 days late. He feels that this is irritating, and commonly leads to dissatisfaction that may well trigger a lawsuit. The authors agreed and added that problems often occur when a disgruntled patient receives a large bill or collection notice. Another writer placed a good deal of the blame squarely on the desire of managed care organizations to save money resulting in increased patient load and a "mass production-like mentality." Dr. Volpintesta, on the other hand, points out that some physicians tend to eliminate patients who might be expected to sue more readily and so reduce their exposure to lawsuits. He also feels that conversely relatives may get into the act and create problems.

In the end, I suppose, what really matters is what has always been of prime importance in human relations, a feeling of good interpersonal relationship between one human being and another. Even parents and their children have been known to sue each other. As a matter of fact, I've never heard of a patient killing his or her doctor when dissatisfied, but family members do it all the time. When I think about it, some of the terrible things that certain doctors have perpetrated on their patients may well have instigated a desire for permanent revenge, but let's face it, why go to jail when you can go to court and come out a multimillionaire.

Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission. Copyright © 2006 by Marvin Ackerman, M.D.

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