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    Physician communication plays key role in dictating patient satisfaction


    David Goldberg, M.D., J.D
    Dr. Speak has a very high-volume, predominantly medical, dermatology practice. He sees about 60 patients a day and finds that he is not able to spend very much time with each one.

    In the medical community, he is known for the quality of his diagnostic skills, but also for his poor communication skills. Patients have often complained that he has a tendency to not only rush them during office visits, but also to be condescending when speaking to them.

    Dr. Speak admits to having had a series of these complications over the years and, like any other human being, has made mistakes. Until two years ago he had never been sued. He is perplexed with this lawsuit, which, although based on negligence, seems to have a peculiar twist.

    During the course of the suit, Dr. Speak finds out that the suing plaintiff, despite being injured, would never have brought the lawsuit if not for his arrogance. Dr. Speak has been advised by his medical malpractice carrier to take classes on communication skills. He is resistant to doing this and cannot understand why he should do so. Is he correct?

    Communication counts

    It is clear that in years past, physicians were actually encouraged to minimize communications with patients when things went wrong. As healthcare has now evolved, accrediting agencies, professional organizations and legislators have begun implementing and adapting policies that require and encourage discussion with patients who have had unanticipated medical errors.

    It has been stated that this lack of communication often results in a lack of trust that leaves the patient feeling deceived. These feelings of deceit and mistrust, it has been suggested, are the driving forces behind some medical practice cases.

    As the drive to move healthcare to a more patient-driven environment continues, communication between provider and patient must improve. One might argue that a high degree of effective communication is a physician's best bet at minimizing and preventing possible malpractice claims, as well as establishing a strong relationship with the patient.

    In fact, a 2005 study in the Archives of Internal Medicine showed that patients are less likely to sue their physicians if their questions are answered, if they are told the truth, if they are treated with compassion and empathy and if the patient-physician relationship is preserved. This study showed that patients taking legal action also desired greater honesty and assurance that lessons are learned from their healthcare provider's mistakes.

    More than words

    Interactions between physicians and patients go far beyond the actual words exchanged. The manner in which physicians communicate is often as important — if not more — than what they communicate. Patients pick up on things such as tone of voice, facial expressions and mannerisms.

    In a 1993 article titled "Listening and Talking to Patients: A Remedy for Malpractice Suits," Lester and Smith found that a physician communicating with a patient in a negative way, such as using a harsh or impatient tone of voice, was more likely to trigger litigious feelings than a physician who communicates with a patient in a positive manner. Even physician tone of voice has been shown to have a major impact on litigious feelings and outcome.

    What is clear is that although positive communications are not an indicator of professional competence, the way in which a physician communicates plays a major role in the development of a healthy patient-physician relationship.

    Dr. Speak would be well-served to improve his communication skills. Doing so may actually stop a patient from suing him.

    David Goldberg, M.D., J.D., is director of Skin Laser & Surgery Specialists of New York and New Jersey; director of laser research, Mount Sinai School of Medicine; and adjunct professor of law, Fordham Law School.

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    David J. Goldberg, M.D., J.D.
    Dr. Goldberg is Director of Skin Laser & Surgery Specialists of New York and New Jersey, Director of Mohs Surgery and laser research, ...

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