Two kids were trying to figure out what game to play.

One suggested, "Let's play doctor."

"Good idea." said the other. "You operate, and I'll sue."

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A Philadelphia OBGYN: “I never thought it would come to this. I no longer have a private practice. I had to sell out to the hospital once the malpractice insurance premiums got too expensive. Now they have midwives doing the deliveries, and I only come in for complications. They know they are going to get sued for just about everything that goes wrong, so they go with the flow and reduced costs with the midwives. The obstetricians are leaving this town left and right, and they are relocating to friendlier cities.”

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Since many malpractice cases are not based on medical mistakes, even the best doctors can, and most likely will, get sued. The doctors with the best bedside manner, who learn to practice defensively, are the ones less likely to end up in court.

A TALE OF TWO DOCTORS

Doctor 1 – One surgeon did a routine I&D (incision and drainage) on a patient who presented with some numbness in the surrounding tissues. After the procedure, the patient sued the surgeon claiming the numbness was caused by the I&D. This particular doctor acts pleasant to his patients, but utilizes none of the skills associated with bedside manner. He doesn’t exhibit any compassion or humor and his communication skills are lacking. He explains options, risks, and consequences minimally. During treatment he makes no effort to interact with the patients. The patient was successful in winning the case on a settlement as the insurance company told him they couldn’t mount any type of defense due to his lack of informed consent.

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Doctor 2 – This radiologist experienced the misfortune of having a fifty-pound x-ray unit fall off the wall mount onto a patient causing a corneal injury. Fortunately, it was a glancing blow and didn’t do extensive damage. The doctor, skilled in all aspects of bedside manner, had formed an immediate bond with this first-time patient before the accident. The night of the accident he made a trip to the patient’s home and sat with her and her husband to tell them how sorry he was for her injury. The patient returned to this doctor for follow-up treatment and she told him how all of her friends and family told her she should sue him. She further explained how she liked him so much and that the visit to her home precluded any chance of her taking any legal action.

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Patients sue for the most unforeseen reasons, quite often due to financial considerations, unexpected outcomes, and sometimes because there are personality conflicts. Naturally, claims have to have merit or they will be dismissed, but that doesn’t mean patients can’t institute legal action. Once you go through the nightmarish process of a lawsuit, you will understand why it is better to have patients that love you. They will almost never want to sue you, even when things go wrong.

Some doctors believe patients come to them solely for their expertise. Of course they come for their expertise, but they would actually like to have a friendly doctor who explains things to them and shows some compassion. So, like it or not, you may have to make some major adjustments to the way you greet and treat your patients. Yes, you are going to have to say good morning with a smile on your face. It’s a good beginning.

The February 19, 1997, issue of the JAMA offers a better understanding of the way bedside manner can help reduce lawsuits. Specific conversational behaviors were noted in doctors who were never sued compared to those with a history of malpractice claims.

The manner in which doctors spoke with patients was a big factor in the way they were perceived. The tone of voice, explaining what the patient could expect and making sure the patient understood information or instructions, helped. It was also found that primary care physicians who used humor were less likely to be sued.

Physicians who had not been sued also spent more time with their patients (18.3 versus 15 minutes). Having patients talk about their concerns and express their opinions went a long way toward connecting with doctors in a positive manner.

Patients don’t want to be rushed, ignored, or treated rudely. It is imperative to take time to answer patients’ questions, especially when things may have not gone well. It never fails; the patient with complications shows up in the middle of a hectic day. While the tendency is to rush the patient, this is the time to pay special attention to their needs. Make sure you explain what went wrong and when you are done ask if they have any questions. If they interrupt in the middle of your explanation, you can politely say, “I want to answer all of you questions as soon as I’ve finished explaining things to you.”