title: The relation of patient satisfaction with complaints against physicians and malpractice lawsuits.
abstract: OBJECTIVE
  A small number of physicians generate a disproportionate share of complaints from patients and of malpractice lawsuits. If these grievances relate to patients' dissatisfaction with care, it might be possible to use commonly distributed patient satisfaction surveys to identify physicians at high risk of complaints from patients and of malpractice lawsuits. We sought to examine associations among patients' satisfaction survey ratings of physicians' performance and complaints from patients, risk management episodes, and rates of malpractice lawsuits.
  
  
  METHODS
  We examined 353 physicians at a large US teaching hospital whose inpatient performance was rated by 10 or more patients between January 1, 2001, and March 31, 2003. Physicians were divided into 3 tertiles according to satisfaction on a commercial survey instrument administered to recently discharged patients. Records of unsolicited complaints from patients (January 1, 2000, to March 31, 2003) and risk management episodes (January 1, 1983, to March 31, 2003) were analyzed after adjusting for the physician's specialty and panel characteristics of the physician's patients.
  
  
  RESULTS
  Decreases in physicians' patient satisfaction survey scores from the highest to the lowest tertile were associated with increased rates of unsolicited complaints from patients (200 vs 243 vs 492 complaints per 100,000 patient discharges; P <0.0001) and risk management episodes (29 vs 43 vs 56 risk management episodes per 100,000 patient discharges; P = 0.007). Compared with physicians with the top satisfaction survey ratings, physicians in the middle tertile had malpractice lawsuit rates that were 26% higher (rate ratio [RR] = 1.26; 95% confidence interval [CI]: 0.72 to 2.18; P = 0.41), and physicians in the bottom tertile had malpractice lawsuit rates that were 110% higher (RR = 2.10; 95% CI: 1.13 to 3.90; P = 0.019).
  
  
  CONCLUSIONS
  Patient satisfaction survey ratings of inpatient physicians' performance are associated with complaints from patients and with risk management episodes. Commonly distributed patient satisfaction surveys may be useful quality improvement tools, but identifying physicians at high risk of complaints from patients and of malpractice lawsuits remains challenging.
authors.affiliation: Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Mass 02114, USA. hstelfox@partners.org
authors.forename: Henry Thomas
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Tejal K
authors.initials: TK
authors.lastname: Gandhi
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Michael L
authors.initials: ML
authors.lastname: Gustafson
mesh_terms: D000328:Adult; D005260:Female; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data*; D008404:Massachusetts; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D012308:Risk Management / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires