The less effectively we communicate, the more likely we are to be sued

As a physician, do you care enough about your patients? It is my belief – and my experience – that physicians care deeply in ways that we demonstrate through our hard work, our commitment, and our willingness to go beyond the ordinary almost every day of our professional lives.  What often gets “lost in the soup” of busyness is the communication of that caring in a mindful, purposeful and comfortable fashion.

The result of purposeful communication, a communication that brings us to full and empathic presence, dwells at the heart of the patient-physician relationship, and helps build a bridge of trust between these two equally important partners on a health-care journey.

What I notice in myself and in others, is that very simple shifts in the way I show up at the bedside, the way I interface with patients, the way I intentionally remember to communicate in a clear and caring way has an amazing impact not only on outcomes and the patient experience, but also on my own experience and level of personal satisfaction.  I simply feel better about how I choose to be at the bedside or in my office.

As health care providers we talk a lot about dissipating anxiety for patients and families but do we really accomplish that? I would suggest that there is an anxiety that is constantly present in many physician communities about time, about pressure, about outcomes and success, about jockeying our way through systems that we don’t completely understand and can’t predict and that anxiety can inadvertently be communicated to our patients.

There are multiple motivators for improved communication skills.  The value-based-purchasing reimbursement model and tandem CAHPS scoring is certainly a financial incentive to have and utilize good communication skills. I think that’s the basis for an increased interest in finding ways to improve the patient experience.  Those scoring tools include direct questions about how health care providers communicate, so communication skills have become a fairly hot topic these days.

I do believe physicians also intrinsically recognize that communicating caring and respect is as important as communicating information and data.  The challenge is that we have been taught well how to deliver diagnoses and details, but have had less opportunity to sharpen the skills of communicating from the heart.

Furthermore, the less clear and caring our communication, the higher the incidence of a malpractice suit being filed.  This is a well-researched topic and a well-established relationship; the less effectively we communicate, the more likely we are to be sued.

Regardless of how many years we’ve been practicing medicine, we all can improve our communication skills. Join me in making it a top priority in your practice for 2013.

Carla J. Rotering is vice president, physician services, Leebov Golde Group. She is the co-author of The Language of Caring Guide for Physicians: Communication Essentials for Patient-Centered Care.

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  • S Raza

    Good article! One comment I have is that your assertion that a conscious effort towards communicating empathetically and positively with patients has “an amazing impact…on my own experience and level of personal satisfaction” may be true for you but may not hold for everyone. For some, maintaining that level of conscious effort can be taxing and a further pressure/source of stress. I do agree that it’s morally required and essential to good practice, but not that it will come as easily as you have implied.

    • Carla Rotering

      I humbly acknowledge that this is a process for me – and for others – and that there are days when I do experience that deep level of personal satisfaction – and there are other days when I recognize that each encounter provides me with an opportunity to learn and grow and choose. It does not, as you note, necessarily come easily and sometimes there are bumps along the way! Thank you so much for sharing your perspective!

  • Suzi Q 38

    Good idea….but I have rarely seen it displayed.
    Doctors are too much in a hurry.
    Sometimes if you have too many questions, they act defensive, therefore shutting off any hope of a response from the patient.
    I think that they should try to welcome any concerns or perceived complaints, so that they can communicate a viable solution quickly.
    This would be in the best interest of the patient.
    Getting defensive and putting off talking about “the elephant in the room” only makes things worse later.

    • Carla Rotering

      Thank you so much for this heartfelt reminder of why it is so important to continue to move forward in this area – I appreciate your candor and hope, as you do, that the communication between doctors, patients, and everyone involved in the delivery of healthcare gets better and better with each passing day!

  • Steve Wilkins

    Timely post on an important subject.

    The importance of good patient communication extends well beyond mitigating the risk of a malpractice claim.. High-quality physician-patient communication, aka patient-centered communication (in the office and hospital) , is closely linked to better patient engagement, more accurate diagnoses, greater patient adherence, fewer lab tests, fewer ER visits and hospital readmissions and of course better patient experiences.

    Patient sue because they do not like their providers. Somewhere along the line they may have felt ignored, dismissed or other wise slighted off too often.

    There is no doubt that most physicians care deeply about their patients. There’s also no question that physicians are very busy.

    But the physician’s patient communication skills are just as important to high quality outcomes and patient safety.. and that reason alone should motivate providers to get serious about improving their patient communication skills.

    Steve Wilkins, MPH
    Mind the Gap

    • Carla Rotering

      I not only deeply appreciate your comments, I also share your sentiments that our collective desire to optimize safety and the quality of our care for patients serve as the noblest incentives to enhance our own communication skills. The literature does confirm the relationship between effective essential communication skills and all of the positive results you described in your response.
      As we step more fully into this “movement”, if you will, I more and more often hear physicians recognizing that really mastering these skills is simply the right thing to do – and I am inspired and hopeful as I hear those voices.
      Thank you for sharing on this important topic.

    • azmd

      Actually the most critical factor in patient safety and high-quality outcomes is ensuring that providers have appropriate amounts of time in which to provide medical care. In the absence of adequate time to provide care, no further tweaking of a provider’s patient communication skills are really going to improve outcomes in any meaningful way. I sometimes suspect that a factor in the great focus on physician communication skills these days is at least in part an attempt by healthcare systems to divert attention from the fact that providers are stretched way too thin to provide good-quality or even reasonably good care.

      The bottom line is if you treat your doctors well and give them reasonable amounts of time to care for their patients, they will do a good job. For the most part, we all went into medicine because we wanted to take good care of people.

  • Docbart

    I agree that communicating with patients leaves the doctor and patient more satisfied with medical visits and is at the heart of building the trust essential to the art of healing.

    It is not always prominent enough in the training of physicians. I suspect that part of the reason for that failure is that many professors are more oriented to research than to clinical practice. During my fellowship, after the professor left the exam room, I would sometimes ask clinic patients if they understood what they had just been told. Many did not.

    During my residency, I encountered a cardiologist, Roger L., who was retiring after many years of practice. He was quite proud of never having even the serious threat of a lawsuit leveled against him. He was not that cautious in his treatment orders. His secret was his rapport with patients and their families. He would take the time to call the family of every hospital patient of his every day and update them. Most doctors hate doing calls like that and avoid doing it, if possible.

    Early in my practice, a medical disaster befell a young uninsured patient I had seen just a couple of times, and he was admitted to the hospital for a very lengthy stay. He had a devastating stroke from which he would never fully recover. It was not my fault, but I cared for him for months and called his family every day. I was totally honest with them. I knew that the urge to sue me would be very powerful and that a jury would find it hard not to award some damages. Many years have gone by since then. They never did sue me. Thanks, Roger.