Why are doctors sued ?Why are doctors sued ?

DR LATA SHARMA DR LATA SHARMA MD , MD , FRANZCOGFRANZCOG

Obstetrics & GynaecologyObstetrics & Gynaecology

Toowoomba Health Service Toowoomba Health Service

Why do Patients Why do Patients complain?complain?

Unexpected adverse outcomesUnexpected adverse outcomes

Unexpected costUnexpected cost

Unmet expectationsUnmet expectations

Why are doctors sued?Why are doctors sued?

Predisposing factors: rudeness, Predisposing factors: rudeness, delaysdelaysinattentiveness, inattentiveness, miscommunication, apathymiscommunication, apathy

Precipitating factors: adverse Precipitating factors: adverse outcomes, iatrogenic failures, outcomes, iatrogenic failures, mistakes, system errorsmistakes, system errors

Which doctors get sued?Which doctors get sued?

Males greater than femalesMales greater than females Doctors aged between 35-55 with Doctors aged between 35-55 with

a peak incidence at 40a peak incidence at 40

Males 60% more likely than the Males 60% more likely than the femalesfemales

87% of complaints relate to care87% of complaints relate to care

provided by male doctorsprovided by male doctors

What motivates patients to What motivates patients to sue?sue?

Adverse outcomes in 3% of admissions Adverse outcomes in 3% of admissions 1 in 4 adverse outcomes 1 in 4 adverse outcomes (1% of total )(1% of total )

due to negligencedue to negligence Only 12 % of patients who suffered Only 12 % of patients who suffered

negligence filed a lawsuitnegligence filed a lawsuit 2 out of 3 claims come from patients 2 out of 3 claims come from patients

with no adverse outcome or an adverse with no adverse outcome or an adverse outcome not due to negligenceoutcome not due to negligence

70% of litigation is related to 70% of litigation is related to poor communicationpoor communication

DesertedDeserted

DevaluedDevalued

Lack of informationLack of information

Lack of understandingLack of understanding

To correct deficient standards of careTo correct deficient standards of care

To find out what happened and whyTo find out what happened and why

To enforce accountabilityTo enforce accountability

Compensation for accrued and future Compensation for accrued and future lossloss

What expectations the patients What expectations the patients have of doctors in the medical have of doctors in the medical encounter?encounter?

The personal qualitiesThe personal qualities The quality of treatment receivedThe quality of treatment received The size of the billThe size of the bill Time spent with patientTime spent with patient Doctor availabilityDoctor availability CompetenceCompetence Treatment from ancillary staffTreatment from ancillary staff Amount of information receivedAmount of information received

Expectations can be realistic OR Expectations can be realistic OR unrealisticunrealistic

Realistic expectations are:-Realistic expectations are:- Adequate timeAdequate time Doctor interested Doctor interested Office staff helpfulOffice staff helpful Doctor’s competenceDoctor’s competence Treated respectfullyTreated respectfully Will be listened toWill be listened to

Unrealistic expectationsUnrealistic expectations

Unlimited timeUnlimited time Available 24/7Available 24/7 Office staff will do all paperworkOffice staff will do all paperwork All treatments will be 100% All treatments will be 100%

successful with no side effectssuccessful with no side effects All issues will be addressed at one All issues will be addressed at one

consultationconsultation

Negative communication behavior Negative communication behavior by by doctors increases litigious intent doctors increases litigious intent even even where there has been no adverse where there has been no adverse outcomeoutcome

One study found that greater One study found that greater than 50% of 263 patients who than 50% of 263 patients who sued their doctor claimed they sued their doctor claimed they were so turned off by the doctor were so turned off by the doctor that they wanted to sue that they wanted to sue him/her before the alleged him/her before the alleged event occurredevent occurred

Two out of three doctors who Two out of three doctors who were sued thought -were sued thought -

Error or negligence was not the factor Error or negligence was not the factor at all in their caseat all in their case

Thought they had been open and Thought they had been open and honest - yet only 30% of their honest - yet only 30% of their patients agreed and 20% thought patients agreed and 20% thought they had been honestthey had been honest

Thought training to improve the Thought training to improve the doctor/patient relationship was very doctor/patient relationship was very effective way to prevent litigationeffective way to prevent litigation

First impression countsFirst impression counts

Patients start formulating Patients start formulating opinions about the doctor opinions about the doctor before they have settled in to before they have settled in to the chair, the staff, the the chair, the staff, the practice and the greetingpractice and the greeting

Greeting the patientGreeting the patient

Maintain eye contactMaintain eye contact

Welcome the patientWelcome the patient

Ensure eye levels are sameEnsure eye levels are same

Make a professional connectionMake a professional connection

Interactional behaviorInteractional behavior

NON SUED - NON SUED - Asked the patient’s opinionAsked the patient’s opinion Patient perceived that Patient perceived that

sufficient time was spentsufficient time was spent LaughedLaughed Explained the process of the Explained the process of the

consultationconsultation

SUED –SUED – Patient felt rushedPatient felt rushed Received no explanationReceived no explanation Less time spentLess time spent Felt ignoredFelt ignored

Importance of non-verbal Importance of non-verbal communicationcommunication

80% of all communication is non-80% of all communication is non-verbalverbal

Doctors who are competent with Doctors who are competent with verbal communication have a verbal communication have a higher patient satisfaction scorehigher patient satisfaction score

Poor body language in emotionally Poor body language in emotionally charged events can lead to charged events can lead to doctor/patient relationship doctor/patient relationship breakdownbreakdown

Patients can determine change Patients can determine change in a clinician s emotion from a in a clinician s emotion from a facial expressions in 375 facial expressions in 375 millisecondsmilliseconds

Doctors with good non-verbal Doctors with good non-verbal communicatons skills are rated as communicatons skills are rated as more caring by their patientsmore caring by their patients

Survey by HCCC (290 patients Survey by HCCC (290 patients between Feb 1997 - August between Feb 1997 - August 1997 )1997 )

64% of complaints were about the 64% of complaints were about the clinical care, 22% related to clinical care, 22% related to rudeness and poor communication, rudeness and poor communication, 14% unethical and improper 14% unethical and improper behaviorbehavior

70% of complaints were from 70% of complaints were from women and 44% were currently on women and 44% were currently on behalf of another personbehalf of another person

Survey by HCCC continued -Survey by HCCC continued -

Complainants had high socio-Complainants had high socio-economic status and 60% were in economic status and 60% were in paid employmentpaid employment

More than half the incidents More than half the incidents happened during consultation. happened during consultation. 87% of the doctors were men and 87% of the doctors were men and over half of these were GPs.over half of these were GPs.

Survey by HCCC continued -Survey by HCCC continued -

37% of complaints were dismissed, 37% of complaints were dismissed, 21% did not know the outcome of 21% did not know the outcome of their complaint and 40% believed that their complaint and 40% believed that the doctor had been disciplinedthe doctor had been disciplined

Most complainants were dissatisfied Most complainants were dissatisfied with the outcome. 25% stated they with the outcome. 25% stated they would sue, 70% would do nothing would sue, 70% would do nothing further. All but 2 complainants would further. All but 2 complainants would never go back to that doctor again. never go back to that doctor again.

Conclusion of the surveyConclusion of the survey

Most of the respondents were not Most of the respondents were not satisfied with either process of the satisfied with either process of the outcome. Typically they wanted outcome. Typically they wanted stronger measures taken. Only few stronger measures taken. Only few wanted compensation.wanted compensation.

More wanted acknowledgement of More wanted acknowledgement of harm done and most wanted the harm done and most wanted the doctor punisheddoctor punished

Techniques of improving non-Techniques of improving non-verbal communicationsverbal communications

Adopt postures, gestures and Adopt postures, gestures and expressionsexpressions

We naturally mirror people we like We naturally mirror people we like Mirroring id mimicryMirroring id mimicry Rushed postures lead to patient Rushed postures lead to patient

discomfortdiscomfort Eye contact is criticalEye contact is critical

DocumentationDocumentation

Success depends on credibility - which is Success depends on credibility - which is more believablemore believable

Evidence whose statement of fact is Evidence whose statement of fact is more acceptablemore acceptable

Poor documentation and record keeping Poor documentation and record keeping -66% of cases damages awarded-66% of cases damages awarded

Adequate documentation and record Adequate documentation and record keeping - 33 % of cases damages keeping - 33 % of cases damages awardedawarded

DocumentationDocumentation

Good documentation includes:- Good documentation includes:- Treatment options discussed with Treatment options discussed with patient, advise as to patient, advise as to recommended Mx, recording of recommended Mx, recording of discussions and decisions made discussions and decisions made jointly, actions expected from jointly, actions expected from patient, follow up plans, patient’s patient, follow up plans, patient’s questions answered by the questions answered by the doctor.doctor.

DocumentationDocumentation

Altering documentation should be Altering documentation should be clearly labelled as such, dated and clearly labelled as such, dated and signed.signed.

Altering records in another way Altering records in another way renders them to be, at best, renders them to be, at best, worthless.worthless.

At worst, contributing factor to your At worst, contributing factor to your evidence not being believed.evidence not being believed.

Summary Summary

The cause of litigation is complexThe cause of litigation is complex Is a result of predisposing and Is a result of predisposing and

precipitating factorsprecipitating factors Patients make assessments based Patients make assessments based

on the interactional skills on the interactional skills These arise as a result of unmet These arise as a result of unmet

expectationsexpectations

Prevention involves these key Prevention involves these key elementselements

Understand the motivating factor Understand the motivating factor why patients suewhy patients sue

Intersectional skills Intersectional skills Managing expectations Managing expectations Making a connectionMaking a connection Interacting with staff and colleaguesInteracting with staff and colleagues Documentation Documentation Managing adverse outcomesManaging adverse outcomes

What to do when an adverse What to do when an adverse event occursevent occurs

Inform the patient as soon as possibleInform the patient as soon as possible If a letter of complaint is received, If a letter of complaint is received,

forward a reply promptlyforward a reply promptly Supply information which is detailed and Supply information which is detailed and

factual but contains neither positive nor factual but contains neither positive nor negative “Spin”negative “Spin”

Self flagellations by the doctor or the Self flagellations by the doctor or the hospital involved is inappropriate, but so hospital involved is inappropriate, but so is denial.is denial.

Acknowledge the fact (I appreciate Acknowledge the fact (I appreciate how distressing this is to you) how distressing this is to you)

Express sincere regret and genuine Express sincere regret and genuine concern for the patient’s welfare (I concern for the patient’s welfare (I am sorry this has happened to you)am sorry this has happened to you)

Do not admit liability like I am sorry I Do not admit liability like I am sorry I did this to you . It is inappropriate did this to you . It is inappropriate to admit liability in the heat of the to admit liability in the heat of the moment, calmer reflection and after moment, calmer reflection and after seeking advice, may lead to the seeking advice, may lead to the conclusion that there is no liability.conclusion that there is no liability.

What to do when an What to do when an adverse event occurs adverse event occurs continued -continued -

Doctors can reduce risk by:-Doctors can reduce risk by:-

Paying close attention to the Paying close attention to the quality of their human interactionsquality of their human interactions

Addressing unrealistic expectationsAddressing unrealistic expectations Making good clinical notesMaking good clinical notes Treating staff and colleagues with Treating staff and colleagues with

respect and carerespect and care Avoiding criticism of the care Avoiding criticism of the care

provided by another professionalprovided by another professional

People are reluctant to sue People are reluctant to sue someone they likesomeone they like

Patients Patients don’t caredon’t care how much how much you know until they know how you know until they know how much you much you CARECARE

Doctors can reduce risk by Doctors can reduce risk by continued:-continued:-

So lets do our best and NOT get So lets do our best and NOT get SUEDSUED

THANK YOU ALLTHANK YOU ALL