Cold Blooded Doctors

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Doctors Did you know that the risk of being sued for malpractice has very little to do with how many mistakes a doctor makes? Studies of malpractice lawsuits have revealed that that there are highly skilled doctors who get sued a lot, and doctors who make lots of mistakes that never get sued. It seems that what makes the difference for a patient in deciding whether to file a suit is… their personal interaction with the doctor, of course! Usually people file a suit because they were mistreated AND they were ignored and/or treated poorly. As a leading medical malpractice lawyer, Alice Burkin puts it: “People just don’t sue doctors they like… When a patient has a bad medical result, the doctor has to take the time to explain what happened, and to answer the patient’s questions – to treat him like a human being. The doctors who don’t are the ones who get sued.” Interesting and obvious, yes? The book Blink by Malcolm Gladwell has even more interesting data to offer us regarding all this:

Recently the medical researcher Wendy Levinson recorded hundreds of conversations between a group of physicians and their patients. Roughly half of the doctors had never been sued. The other half had been sued at least twice, and Levinson found that just on the basis of those conversations, she could find clear differences between the two groups. The surgeons who had never been sued spent more than three minutes longer with each patient than those who had been sued did (18.3 minutes versus 15 minutes). They were more likely to make “orienting” comments, such as “First I’ll examine you, and then we will talk the problem over” or “I will leave time for your questions” – which help patients get a sense of what the visit is supposed to accomplish and when they ought to ask questions. They were more likely to engage in active listening, saying such things as “Go on, tell me more about that,” and they were far more likely to laugh and be funny during the visit. Interestingly, there was no difference in the amount or quality of information they gave their patients; they didn’t provide more details about medication or the patient’s condition. The difference was entirely in how they talked to their patients.

It’s possible, in fact, to take this analysis even further. The psychologist Nalini Ambady listened to Levinson’s tapes, zeroing in on the conversations that had been recorded between just surgeons and their patients. For each surgeon, she picked two patient conversations. Then, from each conversation, she selected two ten-second clips of the doctor talking, so her slice was a total of forty seconds. Finally, she “contentfiltered” the slices, which means she removed the high-frequency sounds from speech that enable us to recognize individual words. What’s left after content-filtering is a kind of garble that preserves intonation, pitch, and rhythm but erases content. Using that slice – and that slice alone – Ambady did an analysis.

She had judges rate the slices of garble for such qualities as warmth, hostility, dominance, and anxiousness, and she found that by using only those ratings, she could predict which surgeons got sued and which ones didn’t. Ambady says that she and her colleagues were “totally stunned by the results,” and it’s not hard to understand why. The judges knew nothing about the skill level of the surgeons. They didn’t know how experienced they were, what kind of training they had, or what kind of procedures they tended to do. They didn’t even know what the doctors were saying to their patients. All they were using for their prediction was their analysis of the surgeon’s tone of voice. In fact, it was even more basic than that: if the surgeon’s voice was judged to sound dominant, the surgeon tended to be in the sued group. If the voice sounded less dominant and more concerned, the surgeon tended to be in the non-sued group.

So there you have it, if you want to know which doctors are going to be sued, just listen to a small conversation between each doctor and his or her patients.

Related to all this is a very interesting news item that I found recently:

Physicians Often Miss Opportunities To Show Empathy, Study Finds

ScienceDaily
Sep. 23, 2008)

In consultations with patients with lung cancer, physicians rarely responded empathically to the concerns of the patients about mortality, symptoms or treatment options, according to a study led by a University of Rochester Medical Center researcher.

he study, published in the Archives of Internal Medicine and based on 20 recorded and transcribed consultations, found that physicians missed many opportunities to recognize and possibly ease the concerns of their patients and routinely provided little emotional support.

“When patients are struggling and bring up important issues, doctors don’t have to take a lot of time to address them, but they do need to respond. Showing that they understand and giving their patients more of what they need is not that difficult,” said Diane Morse, M.D., assistant professor of psychiatry and of medicine at the Medical Center.

The study sheds light on the types of situations and remarks that physicians should recognize as opportunities to express understanding and support, she said. The research also showed that empathic responses can be brief and do not make consultations longer.

Morse and her researchers examined 20 representative transcripts from recordings of 137 consultations between physicians at a Veterans Affairs hospital in the southern United States and patients with lung cancer or a pulmonary mass requiring surgical diagnosis.

Empathy — the identification with and understanding of another person’s situation and feelings — is considered an important element of communication between patients and physicians and is associated with improved patient satisfaction and compliance with recommended treatment.

In the transcribed consultations, the researchers identified 384 moments or “empathic opportunities” when patients stated or alluded to concerns, emotions or stressors. These included statements about the impact of cancer, diagnosis, treatment or health care system barriers to care. They found that physicians responded empathically to 39, or just 10 percent of the opportunities.

The article reports several typical conversations where empathic opportunities were missed when a physician did not respond to a patient’s clue to important concerns or simply changed the subject. In one, a patient mentions the amount of time he can expect to live.

Patient: I don’t know what the average person does in just two year, three years, a year?

Physician: I think that . . . you certainly could live two or three years. I think it would be very unlikely . . . But I would say that an average figure would be several months to a year to a little bit more.

Another patient discusses smoking, perhaps wanting to discuss his regret for the role of smoking in his cancer.

Patient: No, sir, I’ve never had a heart attack, Supposedly, I worked very hard when I was a young man, a young boy. I was doing a man’s labor and I was always told I had a good strong heart and lungs. But the lungs couldn’t withstand all that cigarettes . . .

Physician: Yeah.

Patient: Asbestos and pollution and second-hand smoke and all these other things, I guess.

Physician: Do you have glaucoma?

Morse and her co-authors suggest that physicians who have patients with a life-threatening illness should consider providing empathy early in the encounter and throughout treatment to validate patient needs and explore ways to build understanding. The connection can begin with a simple phrase, such as: “It sounds like you are very concerned about that.”

The research is consistent with several studies that reported primary care physicians, oncologists and surgeons infrequently make empathic responses. Morse suggests physicians, while busy with many tasks, might avoid empathic opportunities, especially those about mortality, because they are difficult to address.

“This difficulty may be related to limited cure potential that results in a sense of failure and/or identification with the patient that is difficult for the physician to acknowledge or express and may raise within the physician awareness of his or her own vulnerability to illness and mortality,” the researchers state.

The other authors of the article are Elizabeth A. Edwardsen, M.D., associate professor of emergency medicine at the University of Rochester Medical Center, and Howard S. Gordon, M.D., staff physician at Jesse Brown Veterans Administration Medical Center and associate professor of medicine at the University of Illinois at Chicago College of Medicine.

I guess that’s why physicians just aren’t that popular anymore! Oh, by the way – did you know that a lack of empathy is a psychopathic trait?

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