1. Why are doctors sued ? DR LATA SHARMA MD, FRANZCOG Obstetrics & Gynaecology Toowoomba Health Service

2. Why do Patients complain? b Unexpected adverse outcomes b Unexpected cost b Unmet expectations

3. Why are doctors sued? b Predisposing factors: rudeness, delays inattentiveness, miscommunication, apathy b Precipitating factors: adverse outcomes, iatrogenic failures, mistakes, system errors

4. Which doctors get sued? Which doctors get sued? b Males greater than females b Doctors aged between 35-55 with a peak incidence at 40

5. b Males 60% more likely than the females b 87% of complaints relate to care provided by male doctors provided by male doctors

6. What motivates patients to sue? What motivates patients to sue? b Adverse outcomes in 3% of admissions b 1 in 4 adverse outcomes (1% of total ) due to negligence b Only 12 % of patients who suffered negligence filed a lawsuit b 2 out of 3 claims come from patients with no adverse outcome or an adverse outcome not due to negligence

7. 70% of litigation is related to poor communication b Deserted b Devalued b Lack of information b Lack of understanding

8. b To correct deficient standards of care b To find out what happened and why b To enforce accountability b Compensation for accrued and future loss

9. What expectations the patients have of doctors in the medical encounter? b The personal qualities b The quality of treatment received b The size of the bill b Time spent with patient b Doctor availability b Competence b Treatment from ancillary staff b Amount of information received

10. Expectations can be realistic OR unrealistic Realistic expectations are:- b Adequate time b Doctor interested b Office staff helpful b Doctor’s competence b Treated respectfully b Will be listened to

11. Unrealistic expectations b Unlimited time b Available 24/7 b Office staff will do all paperwork b All treatments will be 100% successful with no side effects b All issues will be addressed at one consultation

12. Negative communication behavior by doctors increases litigious intent even where there has been no adverse outcome One study found that greater than 50% of 263 patients who sued their doctor claimed they were so turned off by the doctor that they wanted to sue him/her before the alleged event occurred

13. Two out of three doctors who were sued thought - b Error or negligence was not the factor at all in their case b Thought they had been open and honest - yet only 30% of their patients agreed and 20% thought they had been honest b Thought training to improve the doctor/patient relationship was very effective way to prevent litigation

14. First impression counts b Patients start formulating opinions about the doctor before they have settled in to the chair, the staff, the practice and the greeting

15. Greeting the patient b Maintain eye contact b Welcome the patient b Ensure eye levels are same b Make a professional connection

16. Interactional behavior NON SUED - b Asked the patient’s opinion b Patient perceived that sufficient time was spent b Laughed b Explained the process of the consultation

17. SUED – b Patient felt rushed b Received no explanation b Less time spent b Felt ignored

18. Importance of non-verbal communication b 80% of all communication is non-verbal b Doctors who are competent with verbal communication have a higher patient satisfaction score b Poor body language in emotionally charged events can lead to doctor/patient relationship breakdown

19. Patients can determine change in a clinician s emotion from a facial expressions in 375 milliseconds b Doctors with good non-verbal communicatons skills are rated as more caring by their patients

20. Survey by HCCC (290 patients between Feb 1997 - August 1997 ) b 64% of complaints were about the clinical care, 22% related to rudeness and poor communication, 14% unethical and improper behavior b 70% of complaints were from women and 44% were currently on behalf of another person

21. Survey by HCCC continued - b Complainants had high socio-economic status and 60% were in paid employment b More than half the incidents happened during consultation. 87% of the doctors were men and over half of these were GPs.

22. Survey by HCCC continued - b 37% of complaints were dismissed, 21% did not know the outcome of their complaint and 40% believed that the doctor had been disciplined b Most complainants were dissatisfied with the outcome. 25% stated they would sue, 70% would do nothing further. All but 2 complainants would never go back to that doctor again.

23. Conclusion of the survey b Most of the respondents were not satisfied with either process of the outcome. Typically they wanted stronger measures taken. Only few wanted compensation. b More wanted acknowledgement of harm done and most wanted the doctor punished

24. Techniques of improving non-verbal communications b Adopt postures, gestures and expressions b We naturally mirror people we like b Mirroring id mimicry b Rushed postures lead to patient discomfort b Eye contact is critical

25. Documentation b Success depends on credibility - which is more believable b Evidence whose statement of fact is more acceptable b Poor documentation and record keeping - 66% of cases damages awarded b Adequate documentation and record keeping - 33 % of cases damages awarded

26. Documentation b Good documentation includes:- Treatment options discussed with patient, advise as to recommended Mx, recording of discussions and decisions made jointly, actions expected from patient, follow up plans, patient’s questions answered by the doctor.

27. Documentation b Altering documentation should be clearly labelled as such, dated and signed. b Altering records in another way renders them to be, at best, worthless. b At worst, contributing factor to your evidence not being believed.

28. Summary b The cause of litigation is complex b Is a result of predisposing and precipitating factors b Patients make assessments based on the interactional skills b These arise as a result of unmet expectations

29. Prevention involves these key elements b Understand the motivating factor why patients sue b Intersectional skills b Managing expectations b Making a connection b Interacting with staff and colleagues b Documentation b Managing adverse outcomes

30. What to do when an adverse event occurs b Inform the patient as soon as possible b If a letter of complaint is received, forward a reply promptly b Supply information which is detailed and factual but contains neither positive nor negative “Spin” b Self flagellations by the doctor or the hospital involved is inappropriate, but so is denial.

31. b Acknowledge the fact (I appreciate how distressing this is to you) b Express sincere regret and genuine concern for the patient’s welfare (I am sorry this has happened to you) b Do not admit liability like I am sorry I did this to you. It is inappropriate to admit liability in the heat of the moment, calmer reflection and after seeking advice, may lead to the conclusion that there is no liability. What to do when an adverse event occurs continued -

32. Doctors can reduce risk by:- b Paying close attention to the quality of their human interactions b Addressing unrealistic expectations b Making good clinical notes b Treating staff and colleagues with respect and care b Avoiding criticism of the care provided by another professional

33. b People are reluctant to sue someone they like b Patients don’t care how much you know until they know how much you CARE Doctors can reduce risk by continued:-

34. So lets do our best and NOT get SUED

35. THANK YOU ALL