Back to the future: Can conversation analysis be used to judge physicians’ malpractice history?
Issue: Vol 11 No. 1 (2014)
Journal: Communication & Medicine
Subject Areas: Healthcare Communication Linguistics
Abstract:
In its monograph Crossing the Quality Chasm, the Institute of Medicine asserted that 44,000 to 98,000 lives are lost every year due to avoidable medical errors, more than 80% of which involved breakdowns in communication. Medical malpractice claims also involve errors that cause harm, including death. Reasons for malpractice claims have been investigated using variables such as age, race, country of origin, and gender, none of which are predictive. One promising area that has not systematically been studied is the role of face-to-face communication in malpractice claims. To better understand this phenomenon, we tape-recorded 125 doctors (divided equally between surgeons and primary care practitioners), each with 10 consecutive patients. Half of these doctors had been sued at least twice, while the rest had never been sued. We then did a qualitative analysis based on a single taped encounter per doctor using conversation analysis (CA), in order to try to identify which doctors had claims or no-claims histories. While we were able to identify two out of every three no-claims primary care doctors, we were much less successful in identifying those with claims. Surprisingly, in the surgeon group, predictions based on CA were worse than by chance probability. We discuss the implications of our findings for the field of outcome-based communication analysis.
Author: Richard M. Frankel, Wendy Levinson
References :
Beckman, H. B., Markakis, K. M., Suchman, A. L. and Frankel, R. M. (1994) The doctor-plaintiff relationship: Lessons from plaintiff depositions. Archives of Internal Medicine 154 (12): 1365–1370. http://dx.doi.org/10.1001/archinte.1994.00420120093010
Bosk, C. (1979) Forgive and Remember: Managing Medical Failure. Chicago, IL: University of Chicago Press.
Carter, W. B., Inui, T. S., Kukull, W. A. and Haigh, V. H. (1982) Outcome-based doctor–patient interaction analysis: II. Identifying effective provider and patient behavior. Medical Care 20 (6): 550–566. http://dx.doi.org/10.1097/00005650-198206000-00002
Cicourel, A. (1964) Method and Measurement in Sociology. New York: The Free Press.
Cicourel, A. (1981) Language and medicine. In C. Ferguson and S. B. Heath (eds) Language in the USA, 407–429. Cambridge: Cambridge University Press.
Denzin, N. K. (1970) The Research Act. Chicago, IL: Aldine Publishers.
Entman, S. S., Glass, C. A., Hickson, G. B., Githens, P. B., Whetten-Goldstein, K. and Sloan, F. A. (1994) The relationship between malpractice claims history and subsequent obstetric care. Journal of the American Medical Association 272 (20): 1588–1591. http://dx.doi.org/10.1001/jama.1994.03520200044033
Frankel, R. M. (1999) Standards of qualitative research. In B. Crabtree and W. Miller (eds) Doing Qualitative Research. Second edition, 333–346. Newbury Park, CA: Sage.
Garfinkel, H. (1967) Studies in Ethnomethodology. Englewood Cliffs, NJ: Prentice Hall.
Greenfield, S., Kaplan, S. and Ware, J. (1985) Expanding patient involvement in care: Effects on patient outcomes. Annals of Internal Medicine 102 (4): 520–528. http://dx.doi.org/10.7326/0003-4819-102-4-520
Headache Study Group (1986) Predictors of outcome in patients presenting to family doctors: A one year prospective study. Headache 26 (6): 285–294. http://dx.doi.org/10.1111/j.1526-4610.1986.hed2606285.x
Hickson, G. B., Clayton, E. W. and Entmann, S. S. (1994) Obstetricians’ prior malpractice experience and patients’ satisfaction with care. Journal of the American Medical Association 272 (20): 1583–1587. http://dx.doi.org/10.1001/jama.1994.03520200039032
Hoffman, J. and Raman, S. (2012) Communication factors in malpractice cases. Retrieved from: http://tinyurl.com/k9yo6bv
Institute of Medicine (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press.
Inui, T. S., Carter, W. B., Kukull, W. A. and Haigh, V. H. (1982) Outcome-based doctor–patient interaction analysis 1: Comparisons of techniques. Medical Care 20 (6): 535–549. http://dx.doi.org/10.1097/00005650-198206000-00001
Jefferson, G. (1978) Explanation of transcript notation. In J. Schenkein (ed.) Studies in the Organization of Conversational Interaction, xi–xvi. New York: Academic Press.
Kaplan, S. H., Greenfield, S., Gandek, B., Rogers, W. H. and Ware, J. E. (1996) Characteristics of doctors with participatory decision-making styles. Annals of Internal Medicine 124 (5): 497–504. http://dx.doi.org/10.7326/0003-4819-124-5-199603010-00007
Kennell, J., Klaus, M., McGrath, S., Robertson, S. and Hinkley, C. (1991) Continuous emotional support during labor in a US hospital: A randomized controlled trial. Journal of the American Medical Association 256 (17): 2197–2237. http://dx.doi.org/10.1001/jama.1991.03460170051032
Korsch, B. M., Gozzi, E. K. and Negrete, V. F. (1968) Gaps in doctor-patient interaction and patient satisfaction. Pediatrics 42 (5): 855–871.
Lazare, A., Eisenthal, S. and Wasserman, L. (1975) The customer approach to patienthood: Attending to patient requests in a walk-in clinic. Archives of General Psychiatry 32 (5): 553–558. http://dx.doi.org/10.1001/archpsyc.1975.01760230019001
Legare, F., Ratte, S., Stacey, D., Kryworuchko, J., Gravel, K., Graham, I. D. and Turcotte, S. (2010) Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database of Systematic Reviews 5: CD006732.
Lester, G. W. and Smith, S. G. (1993) Listening and talking to patients: A remedy for malpractice suits? Western Journal of Medicine 158 (3): 268–272.
Levinson, W., Dull, V. T., Roter, D. L., Chaumeton, N. and Frankel, R. M. (1998) Recruiting doctors for office-based research. Medical Care 36 (6): 934–937. http://dx.doi.org/10.1097/00005650-199806000-00016
Levinson, W., Roter, D. L., Mullooly, J. P., Dull, V. T. and Frankel, R. M. (1997) Physician–patient communication: The relationship with malpractice claims among primary care doctors and surgeons. Journal of the American Medical Association 277 (7): 553–559. http://dx.doi.org/10.1001/jama.1997.03540310051034
Ley, P. (1979) Memory for medical information. British Journal of Social and Clinical Psychology 18 (2): 245–255. http://dx.doi.org/10.1111/j.2044-8260.1979.tb00333.x
Matthias, M. S., Salyers, M. P. and Frankel, R. M. (2013) Re-thinking shared decision-making: Context matters. Patient Education and Counseling 91 (2): 176–179. http://dx.doi.org/10.1016/j.pec.2013.01.006
Milmoe, S., Rosenthal, R., Blane, H. T., Chafetz, M. E. and Wolf, I. (1967) The doctor’s voice: Postdictor of successful referral of alcoholic patients. Journal of Abnormal Psychology 72 (1): 78–84. http://dx.doi.org/10.1037/h0024219
Mishler, E. G. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex Publishers.
Moore, P. M., Rivera Mercado, S., Grez Artigues, M. and Lawrie, T. A. 2013. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database of Systematic Reviews 3: CD003751.
Rao, J. K., Anderson, L. A., Inui, T. S. and Frankel, R. M. (2007) Communication interventions make a difference in conversations between doctors and patients: A systematic review of the evidence. Medical Care 45 (4):340–349. http://dx.doi.org/10.1097/01.mlr.0000254516.04961.d5
Roter, D. and Frankel, R. M. (1992) Quantitative and qualitative approaches to the evaluation of the medical dialogue. Social Science & Medicine 34 (10): 1097–1103. http://dx.doi.org/10.1016/0277-9536(92)90283-V
Sacks, H. (1975) Everyone has to lie. In B. Blount and M. Sanches (eds) Sociocultural Dimensions of Language Use, 57–80. New York: Academic Press.
Sacks, H., Schegloff, E. A. and Jefferson, G. (1974) A simplest systematics for the organization of turn-taking for conversation. Language 50 (4): 696–735. http://dx.doi.org/10.2307/412243
Schaeffer, N. C., Garbarski, D., Freese, J. and Maynard, D. W. (2013) An interactional model of the call for survey participation actions and reactions in the survey recruitment call. Public Opinion Quarterly 77 (1): 323–351. http://dx.doi.org/10.1093/poq/nft006
Shuy, R. (1976) The medical interview: Problems in communication. Primary Care 3 (3): 365–386.
Stange, K. C., Miller, W. L., Crabtree, B. F., O’Connor, P. J. and Zyzanski, S. J. (1994) Multimethod research: Approaches for integrating qualitative and quantitative methods. Journal of General Internal Medicine 9 (5): 278–282. http://dx.doi.org/10.1007/BF02599656
Starfield, B., Steinwachs, D., Morris, I., Bause, G., Siebert, S. and Westin, C. (1979) Patient-doctor agreement about problems needing a follow-up visit. Journal of the American Medical Association 242 (4): 344–346. http://dx.doi.org/10.1001/jama.1979.03300040030019
Starfield, B., Wray, C., Hess, K., Gross, R., Birk, P. and D’Lugoff, B. (1981) The influence of patient-practitioner agreement on outcome of care. American Journal of Public Health 71 (2): 127–131. http://dx.doi.org/10.2105/AJPH.71.2.127
Stewart, M. (1995) Effective physician-patient communication and health outcomes: A review. Canadian Medical Association Journal 152 (9): 1423–1433.
Stewart, M., Brown, J. B., Mc Whinney, I. R., Oates, J. and Weston, W. W. (2000) The impact of patient-centered care on patient outcomes. Journal of Family Practice 49 (9): 796–804.
Suchman, A. L., Markakis, K., Beckman, H. B. and Frankel, R. M. (1997) A model of empathic communication in the medical interview. Journal of the American Medical Association 277 (8): 678–682. http://dx.doi.org/10.1001/jama.1997.03540320082047
Taragin, M., Sonnenberg, F., Karns, M., Trout, R., Shapiro, S. and Carson, J. (1994) Does physician performance explain interspecialty differences in malpractice claims rates? Medical Care 32 (7): 661–667. http://dx.doi.org/10.1097/00005650-199407000-00001
Todd, A. D. (1983) A diagnosis of doctor–patient discourse in the prescription of contraception. In S. Fisher and A. D. Todd (eds) The Social Organization of Doctor–Patient Communication, 159–187. Washington, DC: Center for Applied Linguistics.
Treichler, P. A., Frankel, R. M., Kramerae, C., Zoppi, K. and Beckman, H. B. (1984) Problems and problems: Power relationships in a medical encounter. In C. Kramerae, M. Shultz and W. M. O’Barr (eds) Language and Power, 43–61. Beverly Hills, CA: Sage.
Waitzkin, H. and Stoeckle, J. D. (1976) Information control and the micropolitics of health care: Summary of an ongoing research project. Social Science & Medicine 10 (6): 263–276. http://dx.doi.org/10.1016/0037-7856(76)90070-6
Wasserman, R. C., Inui, T. S., Barriatua, R. D., Carter, W. B. and Lippincott, P. (1984) Pediatric clinicians’ support for parents makes a difference: An outcome-based analysis of clinician-patient interaction. Pediatrics 74 (6): 1047–1053.
Weiler, P. C., Hiatt, H. H., Newhouse, J. P., Johnson, W. G., Brennan, T. A. and Leape, L. L. (1993) A Measure of Malpractice: Medical Injury, Malpractice Litigation and Patient Compensation. Cambridge, MA: Harvard University Press.
West, C. (1984) Routine Complications: Troubles with Talk between Doctors and Patients. Bloomington, IN: Indiana University Press.
Williams, G., Grow, V. M., Freedman, Z., Ryan, R. M. and Deci, E. L. (1996) Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social Psychology 70 (1): 115–126. http://dx.doi.org/10.1037/0022-3514.70.1.115