miércoles, 29 de junio de 2011

What makes a patient sue his or her doctor?

Believe it or not, the risk of being sued for malpractice has very little to do with how many mistakes a doctor makes.  Analyses of malpractice lawsuits show that there are highly skilled doctors who get sued a lot and doctors who make lots of mistakes and never get sued. 
At the same time, the overwhelming number of people who suffer an injury due to the negligence of a doctor never file a malpractice suit at all. In other words, patients don’t file lawsuits because they’ve been harmed by shoddy medical care.  Something else happens to them.
What is that something else? It’s how they were treated, on a personal level, by their doctor. What comes up again and again in malpractice cases is that patients say they were rushed or ignored or treated poorly.  “People just don’t sue doctors they like,” is how Alice Burkin, a leading medical malpractice lawyer, puts it.  “In all the years I’ve been in this business, I’ve never had a potential client walk in and say, “ I really like this doctor, and I feel terrible about doing it, but I want to sue him.” We’ve had people come in saying they want to sue some specialist, and we’ll say, “We don’t think that doctor was negligent. We think it’s your primary care doctor who was at fault.” And the client will say, “I don’t care what she did. I love her, and I’m not suing her.”
Burkin once had a client who had a breast tumor that wasn’t spotted until it had metastasized, and she wanted to sue her internist for the delayed diagnosis. In fact, it was her radiologist who was potentially at fault.  But the client was adamant.  She wanted to sue the internist.  “In our firt meeting, she told me she hated this doctor because she never took the time to talk to her and never asked her other symptoms,” Burkin said. “She never looked at me as a whole person,” the patient said.
When a patient has a bad medical result, the doctor has to take the time to explain what happened, and to answer the patient’s questions – to treat him like a human being.  The doctors who don’t are the ones who get sued. It isn’t necessary then, to know much about how a surgeon operates in order to know his likelihood of being sued.  What you need to understand is the relationship between the doctor and his patients.
Recently the medical researcher Wendy Levinson recorded hundreds of conversations between a group of physicians and their patients.  Roughly half of the doctors had never been sued. The other half had been sued at least twice, and Levinson found that just on the basis of those conversations, she could find clear differences between the two groups. 
©      The surgeons who had never been sued spent more than three minutes longer with each patient than those who had been sued did.
©      They were more likely to make “orienting comments” such as “First I’ll examine you, and then we will talk about the problem” or “I will leave time for your questions” – which help patients get a sense of what the visit is supposed to accomplish and when they ought to ask questions.
©      They were more likely to engage in active listening, saying such things as “Go on, tell me more about that.”
©      They were far more likely to laugh and be funny.
©      Interestingly, there was no difference in the amount or quantity of information they gave their patiens, they didn’t provide more details about medication or the patient’s condition.
©      The difference was entirely on how they talked to their patients.
©      The surgeons who sounded dominant or authoritative tended to be in the sued group.
©      The surgeons who sounded less dominant, more concerned tended to be in the non-sued group.
Malpractice sounds like one of those infinitely complicated and multidimensional problems.  But in the end it comes down to a matter of respect and the simplest way to show respect is through the tone of voice, the words you use and your attitude.

Next time you meet a doctor, and you sit down in his office and he starts to talk, if you have the sense that he isn’t listening to you, that he’s talking down to you, and that he isn’t treating you with respect, listen to your feeling and pay attention to it. Most probably it’s telling you something very important.
(“Blink” by M. Gladwell)

Patients need to be listened to by their doctors, need to feel they are important for them as persons not as somebody suffering from an illness.  Every day I see the pain in patients when they are treated absolutely impersonally, when they’re afraid to ask questions, when their doctor doesn’t look them in the eye and the visit to the doctor only last 10 minutes.
The words, looks, movements, gestures, attitude of a doctor are determining factors that can end up in healthy or unhealthy answers to the patient’s state.  No patient should leave a doctor’s consulting room without hope, a decisive element to get the best result of any treatment the patient must undergo.
(“El Laboratorio del Alma” by Stella Maris Maruso)

Does this only apply to doctors and patients? Or all of us who are involved in human interaction should bear this in mind?
In this daily interaction what makes US feel well? What makes US feel bad?
How do we like to be treated by others? How do we treat others?
Maybe this is good food for thought!