Patient Satisfaction: Your Best Defense Against Litigation

Sue Larsen

Few physicians are aware of the strong link between patient satisfaction and medical professional liability risk. Patient satisfaction scores have now emerged as an important indicator of medical liability risk and can be used to identify and support those physicians at high risk of medical liability litigation.

When most physicians think of patient satisfaction, they associate it with patient-experience scores, quality of patient care, Medicare and Medicaid rebates or penalties, and possibly even hospital readmission rates, but few are aware of the strong link between patient satisfaction and medical professional liability risk.

In fact, patient satisfaction scores have now emerged as an important indicator of medical liability risk and can be used to identify and support those physicians at high risk of medical liability litigation.

Let’s take a look at the evidence.

We’ve known for some time that roughly 1 percent of all hospital patients nationwide are harmed in some way, and therefore have legitimate grounds to make a claim. Yet only 3 percent of these patients proceed to file a lawsuit.

An examination of closed claims would indicate that the major cause of the litigation was a failure to diagnose or a medical error. Accordingly, a great deal of time and resources are invested into communicating the importance of thoroughly documenting the diagnostic process and explaining what to do when something goes wrong. Indeed, these approaches are extremely important, and their value should not be underestimated.

The legal process is, however, designed to report only the factual aspects of what went wrong and does not identify why the patientchose to litigate in the first place. When these 3 percent of patients were asked to cite their reasons, the majority named one of four types of communication problems: feeling deserted, feeling devalued, feeling dissatisfied with the information provided,or feeling that their perspective was not understood. These “triggers” all relate to the patient’s perception of how the physician treated them.

Most patients will forgive if they feel they’ve been treated with respect, but when patients feel devalued, ignored, deserted, or when information has been delivered poorly, anger—not injury—drives their decision to litigate, and the medical error simply creates fuel for the fire.

Providing quality patient interactions may therefore be one of the best defenses against litigation. The new research evaluating patient satisfaction scores is adding further weight to this view.

The Correlation Between Medical Liability Claims and Patient Satisfaction
Research conducted at Massachusetts General Hospital showed a clear correlation between medical malpractice claims and patient satisfaction.

For every 1-point decrease in patient satisfaction scores, there was a 6 percent increase in complaints and 5 percent increase in riskmanagement events. Conversely, as patient satisfaction increased, patient complaints and litigation decreased. These results were directly influenced by the quality of the patient interaction and relationship, and not by any other patient-satisfaction measure.

Furthermore, physicians who ranked in the middle tier for patient-satisfaction scores had a 26 percent higher
malpractice lawsuit rate than those physicians in the top third. Alarmingly, physicians in the bottom third had a
110 percent higher lawsuit rate than those in the top third of the data set. Not only does this research clearly link patient satisfaction with medical malpractice risk, but it also provides an invaluable, evidence-based means of identifying physicians who are at highest risk.

Given that patient satisfaction is such an important and multifaceted factor in determining medical malpractice risk, it makes sense to consider which patient-satisfaction measures are the most important in driving overall patient satisfaction scores.Essentially, what do patients want most from their physicians? Analysis of the data has consistently shown physician communication is the driving force.

Key Patient Interactions
Specifically, the data has shown that to achieve high patient-satisfaction scores and subsequently reduce risk of medical professional liability litigation, physicians should address the following in their patient interactions:

1. Show respect and listen carefully. This begins with how you start each encounter. A smile, eye contact, a personal greeting, and a general social comment will go a long way.

Ask them what they think the illness is, what their experience has been, how it is affecting them and what they want from you and acknowledge their responses. This will give you insight into their values and belief systems. Facilitative responses such as "Uh huh ...I see..." can show the patient they’ve been heard without indicating agreement. Reflective statements such as, “If I understand you correctly…” and “Let me recap what I’ve heard…” also show the patient you have listened and are seeking understanding.

When patients feel they have important information to contribute to their diagnosis but their contribution is ignored, they become predisposed to litigate should a missed or delayed diagnosis actually occur.

2. Spend enough time with patients: Avoid the temptation to look at your watch or to talk to them while you have your hand on the door handle to leave. Consider putting a clock on the wall behind the patient so you can keep
track of time. And minimize time spent looking at your computer screen; it detracts from quality time.

Perception is reality.Leaning against a wall of the hospital room or sitting on the end of the bed can give the perception of available time without necessarily increasing actual time spent with the patient.

3. Show knowledge of the patient’s medical history: Read the patients’ notes before you see the patients. It shows that you respect their time and builds their confidence in your ability. It’s not rocket science and may seem minor, but it’s among the top three things patients want and may prevent them from acting out of anger.

4. Adequately address health questions and concerns: Always assume patients have concerns, and ask them what these are. Don’t say, “Do you have any questions?” Instead say, “What questions can I answer for you?” And when you’ve answered the question, make it easy for them to say, without looking foolish,that they haven’t
understood. For example, it is far better to say “Many people find this difficult to understand; what can I clarify for you?” than to say, “Is that clear?”

And always ask, “What other concerns do you have?” until the patient has exhausted the list. Patients often do not lead with their main concern.They may present two or three issues before finally raising the issue they really came to discuss. You can then work with the patient to prioritize concerns and arrange follow-up times, as necessary, to address them all. This simple technique could avoid a delayed or missed diagnosis.

5. Provide explanations that are easy to understand:Nearly half of all adults in the United States have trouble understanding what the doctor tells them about their condition and how to take their medicines.

Patients often say they didn’t know they needed a follow-up appointment, followup tests, or what the out-of-pocket expenses would be, while doctors are adamant these conversations took place. Remember that patients don’t do this every day and can process only a limited amount of new information at one time.

Techniques for effectively delivering information to patients include: using diagrams, saying the same thing in three different ways, using examples, and relating to things the patient already understands.

Patients will be more likely to remember an instruction if you paint a visual picture for them and link it to something
they routinely do. For example, “Keep your tablets with your toothbrush and imagine the pill sitting on top. When you brush your teeth in the morning and at night, you’ll be more likely to remember to take them.”

And ask the patients to repeat back their understanding so you can be confident that they’ve understood it.

The impact of strong physician communication cannot be underestimated. One standard deviation-point increase in the quality of the interaction is associated with a 35 percent lower chance of a patient complaint.

In medical liability, as in medicine, prevention is always better than a cure.Patients are far less likely to sue a doctor they like, so ensure that ongoing interpersonal-skills-development is an important a part of your personal risk prevention strategy.

Contributed by Sue Larsen, cofounder and Chief Operating Officer of Astute Doctor Education, a global education company committed to transforming health care through improved physician bedside manner. Astute Doctor provides a comprehensive suite of physician interpersonal skills courses that improve patient experience and health outcomes, improve health-care efficiencies, and reduce physician risk of malpractice litigation.