title: Stuck in a moment: an ex ante analysis of patient complaints in plastic surgery, used to predict malpractice risk profiles, from a large cohort of physicians in the patient advocacy reporting system.
abstract: BACKGROUND
  Unsolicited patient complaints (UPCs) serve as a powerful predictor of increased risk of malpractice claims, and reductions in UPCs, through targeted physician interventions, lower incidence of lawsuits and decrease cost of risk management. We analyzed UPCs, verified by trained counselors in patient relations, to determine the malpractice risk of plastic surgeons, compared to dermatologists, all surgeons, and all physicians, from a national patient complaint registry.
  
  
  METHODS
  We examined the patient complaint profiles and risk scores of 31,077 physicians (3935 surgeons, 338 plastic and reconstructive surgeons, and 519 dermatologists), who participated in the Patient Advocacy Reporting System, a national registry of UPCs. Patient complaint data were collected from 70 community and academic hospitals across 29 states, from 2009 to 2012. In addition to determining the specific complaint mix for plastic surgery compared to all physicians, each physician was assigned a patient complaint risk score, based on a proprietary weighted-sum algorithm, with a score higher than 70, indicative of high risk for malpractice claims. Patient complaint profiles and risk scores were compared between all groups, using Wilcoxon rank and χ analysis. P values less than 0.05 were assigned statistical significance.
  
  
  RESULTS
  Over this 4-year period, the majority of plastic surgeons (50.8%) did not generate any patient complaints, but those who did received an average of 9.8 complaints from 4.8 patients. The percentage of physicians at high risk for malpractice claims, based upon the Patient Advocacy Reporting System index score of patient complaints, was as follows: all physicians, 2.0%; all surgeons, 4.1%; plastic and reconstructive surgeons, 2.4%; dermatologists, 1.4%. Physicians (from 2012 only) who were identified by their sponsoring institutions as "reconstructive" plastic surgeons (n = 41) were 5 times as likely to have a high risk score, compared to physicians who were identified as "plastic" surgeons (n = 233), and were more likely to practice within an academic health care system that had a level 1 trauma center and a plastic surgery residency program. The overall mix of patient complaints from plastic and reconstructive surgeons was nearly the same as the national cohort of all physicians: care and treatment, 49%; communication, 19%; accessibility and availability, 14%; money or payment issues, 9%; and concern for patient/family, 9%.
  
  
  CONCLUSIONS
  "Reconstructive" plastic surgeons are at increased risk for UPCs, compared to most physicians, especially dermatologists. Because UPCs are a robust proxy for malpractice risk, targeted interventions to decrease patient complaints may improve patient satisfaction and reduce malpractice claims and risk management activity. Monitoring UPCs may permit early identification of high-risk surgeons before malpractice claims accumulate.
authors.affiliation: From the *Division of Plastic Surgery, University of North Carolina Health Care System; and †Center for Patient and Professional Advocacy, Vanderbilt Univeristy.
authors.forename: C Scott
authors.initials: CS
authors.lastname: Hultman
authors.forename: Robert
authors.initials: R
authors.lastname: Gwyther
authors.forename: Michael A
authors.initials: MA
authors.lastname: Saou
authors.forename: James W
authors.initials: JW
authors.lastname: Pichert
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Catron
authors.forename: William O
authors.initials: WO
authors.lastname: Cooper
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Hickson
mesh_terms: D003880:Dermatology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008318:Malpractice; D010344:Patient Advocacy; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D012306:Risk; D066231:Surgeons / Q000706:statistics & numerical data*; D013518:Surgery, Plastic / Q000706:statistics & numerical data*; D014481:United States