The University of Chicago Magazine

April 1997


Good Medicine

Professor of medicine Wendy Levinson finds that doctors who take time to talk with their patients are less likely to be sued for malpractice.

Common sense tells us that people want doctors they can talk to-doctors who listen to them and laugh with them, who encourage questions and check to be sure instructions are understood. What common sense may not tell us--but a new study led by U of C professor of medicine Wendy Levinson does--is that doctors who don't communicate well are more likely to get slapped with a lawsuit.

Previous studies, explains Levinson, have found "a big discrepancy between malpractice occurrences and what goes to litigation. Many events which are potentially negligent and could be litigated don't go to suits, and many things which are not at all breaches in good care go to the litigation system."

So what makes a patient with a bad outcome decide whether or not to file a claim? Levinson and her colleagues--four doctors from other U.S. universities and hospitals--suspected communication could be a major factor. By listening to routine physician-patient interactions, they hoped to be able to predict which doctors had been sued and which hadn't. Would their communication behaviors differ-and if so, how?

Published in the February 19 issue of the Journal of the American Medical Association, the researchers' quantitative findings analyzed audiotapes of ten routine visits to each of 59 primary-care physicians and 65 surgeons in Colorado and Oregon. The physicians and surgeons were subdivided into two groups: those who had no malpractice claims against them and those who had two or more.

Levinson, who joined the University's Medical Center in January as section chief of general internal medicine, and her colleagues coded statements from the 1,265 tapes for "content," "process," or "emotional affect." Content included all medical information; process involved orientation about the flow of the visit ("First I'm going to examine you, then after that we're going to get to talk"); and emotion encompassed support or approval, empathy or concern, plus humor or criticism of third parties ("It's pretty stupid for the insurance company to do that").

The medical information conveyed didn't matter nearly as much as how the doctors said it. Analyzing the statements as communications per minute, the researchers found that the "not-sued" primary-care physicians injected more humor into their conversation. They also used more "facilitating" statements with patients: asking their opinions, encouraging them to talk about concerns, telling them what to expect during visits, and making sure instructions were clear. Physicians who had not been sued also spent slightly longer with their patients--18.3 minutes, as opposed to 15.

These findings, however, did not hold true for the surgeons. "One option is that it's not routine daily communications that matter to surgeons, but it's more what they do when things go badly," Levinson hypothesizes. Or, she suggests, patients may not expect the same levels of compassion or personal relationships from surgeons, putting more emphasis on their technical skills. But, notes Levinson, "Competence doesn't stop with the technical."

She hopes that the in-progress qualitative analysis--which could be released in six months--will offer deeper insight into the kinds of communication skills that are more appropriate for surgeons.

"Medical education-in medical school, residency after medical school, and continuing medical education-has not emphasized as much as it might the importance of physician-patient communication," says Levinson. The doctor-patient interview is the most important procedure in medicine, she argues, because it's the most common.

Even more important than doctors reducing their risk for malpractice claims, she says, "there are very important implications in terms of patients believing us and trusting us, following our instructions-and as a result having good outcomes, because they do some of the things that physicians have suggested."--Written by Kim Sweet

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