The rising number of malpractice claims led against medical providers has captured the attention of both the medical community and the public. Discussions of malpractice management have centered around what steps practitioners can take to reduce the risks formal practice lawsuits in the future. A study by Studdert and colleagues published in The New England Journal of Medicine found that approximately 1% of medical practitioners accounted for nearly 32% of all surveyed malpractice claims, and that the risk for recurrence of malpractice filings increased among providers with multiple paid claims.1 Prior research has further linked the receipt of unsolicited patient observations with an increased risk for malpractice fillings.2
Because unsolicited patient claims can potentially predict whether malpractice lawsuits are eventually filed, researchers have wondered whether they could also be used to determine the risk for treatment-related complications. A retrospective cohort study published in American Journal of Medical Quality found a significant interaction between the number of complaints received by a surgeon and the potential for adverse surgical outcomes (P < .01).3 Additionally, a study published in Journal of the American College of Surgeons showed that poor teamwork in the operating room correlated with adverse surgical outcomes.4 If these factors could be managed, could surgical outcomes be improved?
Researchers led by William O Cooper, MD, MPH, Cornelius Vanderbilt Professor of pediatrics and professor of health policy at Vanderbilt University School of Medicine (Nashville, TN), hypothesized that surgeon complaint records could be used to determine whether patients faced an increased risk for postsurgical complications. In a paper published in JAMA Surgery,5 Dr Cooper and colleagues observed a significant association between prior unsolicited communications and increased risk for any complications (odds ratio [OR] = 1.0063; 95% CI, 1.0004-1.0123; P = .03), any surgical complications (OR = 1.0104; 95% CI, 1.0022-1.0186; P = .01), any medical complications (OR = 1.0079; 95% CI, 1.0009-1.0148; P = .03), and hospital readmission (OR = 1.0088; 95% CI, 1.0024-1.0151; P = .007). Multivariable analyses that controlled for patient, surgeon, and procedural characteristics still showed significantly higher increased risks in all areas for patients whose surgeons had high unsolicited complaint rates. After adjustment, the researchers found the risk for complications among patients whose surgeons were in the highest quartile of unsolicited communications was 13.9% higher than patients whose surgeons were in the lowest quartile.
Journal of Clinical Pathways spoke with Dr Cooper to get a better understanding of how past observations can influence future outcomes, and how patients, providers, and the health care system in general can use these data to improve the consistency and quality of overall care.
What was the impetus to conduct this research?
There is a body of research over the past 20 years that examines the risk for malpractice lawsuits for physicians, which has found over and over that a small number of physicians account for a disproportionate share of lawsuits. Because some of that research has suggested that we can identify these individuals also from the number of patient complaints they receive, we wondered whether patients were picking up on some way that physicians may be interacting with both patients and their teams that might lead to poor overall quality.
And this is important because malpractice claims have the potential to negatively impact the entire health care system?
Definitely. Malpractice is bad for the patient, bad for the provider, and bad for everyone overall. So we should always be sure that we are taking whatever steps we can to stop potential problems in their tracks by providing high-quality care from the beginning.
So why do you think that complication risks are higher for these particular doctors, who have a lot of complaints made against them?
Patients are in a unique position to make observations about their care and about their physicians. When they identify rude or disrespectful behavior coming from their surgeon, they may be picking up on ways that those surgeons interact with others. For example, if a surgeon is repeatedly rude to an anesthesiologist or to an operating-room nurse, when those individuals are working together as a team, it is possible that those individuals may be distracted by the surgeon and worried what he or she may be doing next. Because of that, they all might not be as focused on the task at hand—the care of the patient, the mandate to provide them with the best possible care—as they should be. And we surmised that complications could arise from that, because maybe they were not always as focused as they could or should be.
Is there a way for patients to be apprised of the volume of these complaints when they are first beginning a relationship with a doctor?
Patients play a really critical role as members of the health care team. If a patient is unhappy with the care they receive, or if they feel they have not been treated well by the surgeon, the health care system is going to want to hear about that. In a large health care system like a hospital, patients can call and ask to speak with the patient relations department to share their observations. Patients can directly request a change of surgeon, or they can give their feedback after the fact in order to address the matter. Most organizations have programs in place to address patient dissatisfaction.
What would you say are some of the ways that hospital administrations or continuing medical education can reduce these issues in the future?
We have already shown that when you share these data with physicians in a nonjudgmental way, they will self-correct. In doing this, they can both reduce the volume of complaints they receive in the future, and reduce their risk for future malpractice claims against them.
Is that something you plan to study in a future paper?
Yes. We would be interested in studying whether or not sharing patient perceptions of rudeness or disrespectfulness in a nonjudgmental manner improves physician communication and leads to better outcomes for the patient.
References
1. Studdert DM, Bismark MM, Mello MM, Singh H, Spittal MJ. Prevalence and characteristics of physicians prone to malpractice claims. N Engl J Med. 2016;374(4):354-362.
2. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. JAMA. 2002;287(22):2951-2957.
3. Catron TF, Guillamondegui OD, Karrass J, et al. Patient complaints and adverse surgical outcomes. Am J Med Qual. 2016;31(5):415-422.
4. Makary MA, Sexton JB, Freischlag JA, et al. Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg. 2006;202(5):746-752.
5. Cooper WO, Guillamondegui OD, Hines OJ, et al. Use of unsolicited patient observ tions to identify surgeons with increased risk for postoperative complications [published online February 15, 2017]. JAMA Surg. doi:10.1001/jamasurg.2016.5703
