title: Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.
abstract: OBJECTIVE
  To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons.
  
  
  METHODS
  Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician.
  
  
  METHODS
  One hundred twenty-four physician offices in Oregon and Colorado.
  
  
  METHODS
  Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (> or =2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty.
  
  
  METHODS
  Audiotape analysis using the Roter Interaction Analysis System.
  
  
  RESULTS
  Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons.
  
  
  CONCLUSIONS
  Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.
authors.affiliation: Department of Medicine, Oregon Health Sciences University, Portland, USA.
authors.forename: W
authors.initials: W
authors.lastname: Levinson
authors.forename: D L
authors.initials: DL
authors.lastname: Roter
authors.forename: J P
authors.initials: JP
authors.lastname: Mullooly
authors.forename: V T
authors.initials: VT
authors.lastname: Dull
authors.forename: R M
authors.initials: RM
authors.lastname: Frankel
mesh_terms: D003120:Colorado; D003142:Communication; D005194:Family Practice; D013502:General Surgery; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009819:Office Visits; D009922:Oregon; D017060:Patient Satisfaction; D010817:Physician-Patient Relations