Malpractice Claims History Research Articles

Surgeons' tone of voice: A clue to malpractice history

Background. Interpersonal aspects of care, such as the communication behaviors of physicians, are often cited as central to patients' decisions to initiate malpractice litigation. Relatively little is known, however, about the impact of the communication behaviors of surgeons. In the current study, we investigated the relationship between judgments of surgeons' voice tone and their malpractice claims history. Methods. We examined the relationship between surgeons' voice tone during routine office visits and their history of malpractice claims. Surgeons were audiotaped while speaking to their patients during office visits, and very brief samples of the conversations were rated by coders blind to surgeons' claims status. Two 10-second clips were extracted for each surgeon from the first and last minute of their interactions with 2 different patients. Several variables were rated that assessed warmth, hostility, dominance, and anxiety from 10-second voice clips with content and 10-second voice clips with just voice tone. Results. Controlling for content, ratings of higher dominance and lower concern/anxiety in their voice tones significantly identified surgeons with previous claims compared with those who had no claims (odds ratio [OR] 2.74, 95% confidence interval [CI] 1.16 to 6.43 for dominance; OR 0.46, 95% CI 0.21 to 1.01 for concern/anxiety). Conclusions. Surgeons' tone of voice in routine visits is associated with malpractice claims history. This is the first study to show clear associations between communication and malpractice in surgeons. Specific types of affect associated with claims can be judged from brief audio clips, suggesting that this method might be useful in training surgeons. (Surgery 2002;132:5-9.)

The Relationship Between Physicians' Malpractice Claims History and Later Claims-Reply

In Reply. —We welcome these interesting letters that raise some technical issues, as does Mr Smarr's Commentary. 1 The main scientific protection against error is replication. Already, two different research teams, using different databases from different states, have obtained results similar to those in our article. Dr Wertkin accurately notes that we lacked controls for physicians' practice volume. Volume plausibly influences claims frequency and might even be used in setting premiums. However, such information is difficult to obtain. We considered ourselves fortunate that prior work had painstakingly obtained corresponding data from years of directory listings compiled by the American Medical Association. We agree with Dr Frank that adversarial litigation creates substantial stress for everyone but the lawyers. Malpractice claims are relatively rare compared, for example, with automobile claims, especially considering that most insured people drive only part-time. This does not, however, belittle the psychic costs of law, which are one

The Relationship Between Physicians' Malpractice Claims History and Later Claims

To the Editor. —Messrs Bovbjerg and Petronis 1 have investigated the predictive value of data on liability claims and whether this information has any value for predicting future claims or problems with medical quality. Unfortunately, in their article they dealt only with the former issue and not the latter. Since attempting to infer problems with medical quality is the primary use of the NPDB, 2 this omission could be misleading and discredits some of their conclusions. The NPDB was begun to prevent incompetent doctors from jumping from hospital to hospital or state to state. 3 Other than for such gross violators, inferences about medical quality from malpractice claims data are much more difficult to make. In my 10 years practicing cardiology, I have practiced in three settings that had extraordinarily different malpractice exposure. One was a prominent university hospital setting where malpractice suits were extremely rare despite the complex cases

The Relationship Between Physicians' Malpractice Claims History and Later Claims

The Relationship Between Physicians' Malpractice Claims History and Later Claims

Physician-patient communication. A key to malpractice prevention

What factors put physicians at risk for being sued? This is a vital question to practicing physicians since being named in a malpractice suit or, worse yet, going to court is an emotionally distressing event. A suit can lead to personal isolation, humiliation, depression, and even physical illness for physicians.^1,2Understanding malpractice risk factors is also important to malpractice insurance companies, hospitals, and health care systems that seek to provide high-quality care while minimizing their liability and financial risk. See also pp 1583 and 1588. This issue of<i>JAMA</i>contains two articles that explore the relationship between physicians' malpractice claims history and two potential risk factors: quality of medical care and interpersonal communication skills. The study by Entman et al³examined the relationship between malpractice claims history of Florida obstetricians and the quality of the clinical care they provided to patients 5 to 10 years after the claims.

Physician-Patient Communication

What factors put physicians at risk for being sued? This is a vital question to practicing physicians since being named in a malpractice suit or, worse yet, going to court is an emotionally distressing event. A suit can lead to personal isolation, humiliation, depression, and even physical illness for physicians. 1,2 Understanding malpractice risk factors is also important to malpractice insurance companies, hospitals, and health care systems that seek to provide high-quality care while minimizing their liability and financial risk. See also pp 1583 and 1588. This issue of JAMA contains two articles that explore the relationship between physicians' malpractice claims history and two potential risk factors: quality of medical care and interpersonal communication skills. The study by Entman et al 3 examined the relationship between malpractice claims history of Florida obstetricians and the quality of the clinical care they provided to patients 5 to 10 years after the claims.

The Relationship Between Malpractice Claims History and Subsequent Obstetric Care

To determine the relationship between prior malpractice claims experience and the quality of clinical obstetric care. Historical cohort study of obstetricians, classified by their prior malpractice claims experience, with blinded review of medical records from their practices 5 to 10 years later. Florida obstetricians who lost, settled, or defended malpractice claims between 1977 and 1983 and who were still practicing obstetrics in 1987. Objective and subjective assessment of quality of clinical care of patients attended by obstetricians with different histories of malpractice claims. No differences were found in any of the objective or subjective measures of the quality of clinical care provided to patients of obstetricians who were classified into one of four groups according to their prior claims history. No relationship was found between prior malpractice claims experience and the technical quality of practice by Florida obstetricians. Strategies that attempt to identify physicians at risk for future clinical errors by using data on prior malpractice claims (such as the National Practitioner Data Bank) may be misjudging the likelihood that substandard clinical care will be provided by physicians with prior claims.

The relationship between malpractice claims history and subsequent obstetric care

The relationship between malpractice claims history and subsequent obstetric care

The relationship between physicians' malpractice claims history and later claims. Does the past predict the future?

The relationship between physicians' malpractice claims history and later claims. Does the past predict the future?

The Relationship Between Physicians' Malpractice Claims History and Later Claims

To investigate whether an association exists between physicians' past and subsequent claims of medical malpractice, particularly whether a history of even unpaid claims ($0) or small claims (< $30,000) predicts subsequently higher rates of claims, especially large paid claims (> or = $30,000) (all in 1990 dollars). All medical malpractice claims closed in the state of Florida from January 1975 through August 1988 (N = 20,016, 92% involving physicians), matched with the American Medical Association's Physician Masterfile on all practicing physicians in the state of Florida during that period. Claims history was automated into physician-year claims files, then partitioned into a baseline period (1975 through 1980) and a subsequent period (1981 through 1983). Inconsequential claims were excluded, ie, cases closed without a named claimant and without expense for investigation (30.4% of raw claims). Descriptive analysis of all physician claims; odds ratio analysis of physicians in practice throughout both periods (N = 8247), comparing claims experience in baseline vs subsequent period, adjusted for specialty of practice. For all consequential physician claims, 60% were unpaid claims, 17% were small paid claims, and 23% were large paid claims. The 8247 continuously practicing physicians had a total of 6614 claims, averaging 0.9 per year, but 59.2% of physicians had no claims in 9 years, only 13.4% had any paid claims, and 7.2% had multiple paid claims. Less than 8% of physicians had any large paid claims during the baseline period, and less than 7% had any in the subsequent period. Physicians with any baseline claims (whether paid or unpaid, small or large, single or multiple) had elevated odds of subsequent claims (whether defined as any claims, any paid claims, any large claims, or multiple claims) relative to physicians with no baseline claims. With a baseline of all small claims, the adjusted odds ratio for any subsequent claim was 2.84 (95% confidence interval [CI], 2.32 to 3.49), for any subsequent paid claim was 2.97 (95% CI, 2.34 to 3.77), for all large subsequent claims was 2.42 (95% CI, 1.76 to 3.33), and for subsequent multiple claims was 2.83 (95% CI, 2.08 to 3.86). Even having a single unpaid baseline claim approximately doubled the odds. Claims history had predictive value, even with only unpaid claims. Small paid claims were better predictors than unpaid claims, large paid claims were better predictors than small paid claims, and multiple paid claims were better predictors than single paid claims. Claims history of all kinds is a reasonable statistical measure, eg, for the screening purposes of the National Practitioner Data Bank.

The nurse midwife: Malpractice and risk management

This paper proposes to acquaint nurse-midwives with the basic operations and terminology of the malpractice industry; to identify and discuss what kinds of incidents are cobered by the ACNM malpractice insurance policy; to discuss what steps a nurse-midwife should take when an unhealthy outcome occurs; to discuss the facts about the nurse-midwifery profession's malpractice claims history; and to discuss the College's and individual member's responsibilities to carry out peer review and quality assurance activities.