Back to the future: Can conversation analysis be used to judge physicians' malpractice history?

Abstract

In its monograph Crossing the Quality Chasm, the Institute of Medicine asserted that 44,000 to 98,000 lives are lost every year due to avoidable medical errors, more than 80% of which involved breakdowns in communication. Medical malpractice claims also involve errors that cause harm, including death. Reasons for malpractice claims have been investigated using variables such as age, race, country of origin, and gender none of which are predictive. One promising area that has not systematically been studied is the role of face-to-face communication in malpractice claims. To better understand this phenomenon, we tape-recorded 125 doctors (divided equally between surgeons and primary care practitioners), each with 10 consecutive patients. Half of these doctors had been sued at least twice, while the rest had never been sued. We then did a qualitative analysis based on a single taped encounter per doctor using conversation analysis (CA), in order to try to identify which doctors had claims or no-claims histories. While we were able to identify two out of every three no-claims primary care doctors, we were much less successful in identifying those with claims. Surprisingly, in the surgeon group, predictions based on CA were worse than by chance probability. We discuss the implications of our findings for the field of outcome-based communication analysis.