Professionalism in doctor-patient interactions - insights to reduce risk
Summary: What are the main concerns driving professionalism claims involving doctor-patient interactions? Find out the underlying themes across all specialties and insights to reduce your risk of these types of claims, in our analysis.
Sunday, 22 November 2020
Key messages
- Lack of professionalism in the interaction between a doctor and their patient is commonly raised in claims. The frequency of these claims demonstrates the importance patients place on this interaction.
- This analysis suggests that a mismatch between a doctor's intentions and a patient's perceptions is a factor in claims.
- This analysis, along with the medical literature1-4, highlights that maintaining professionalism in your interactions with patients can assist in reducing your risk of a claim or complaint.
1 in 4 claims involved professionalism in doctor-patient interactions
In most of these claims, professionalism concerns were secondary to another issue
- Claims often involve more than one issue.
- Around two-thirds of claims involving professionalism in doctor-patient interactions were primarily focused on another issue (such as the treatment, surgery or diagnosis a patient was given).
Disrespect was a concern in half of these claims
- Disrespect was a common concern about the doctor-patient interaction (e.g. patient felt the doctor was rude, ignored them or was arrogant).
- Another common concern was ineffective communication (e.g. the doctor made irrelevant comments or did not communicate in an understandable way).
- Boundary breach (physical or otherwise and in rare cases assault) and lack of emotional support (e.g. lacking empathy or thoughtfulness) were less common concerns.
Boundary breach concerns were most likely to be assessed as below expected standards
- Following a claim, a medico-legal evaluation is undertaken to assess whether expected standards of care were met.
- Overall, 14% of these claims were assessed as being below expected standards and 78% as meeting the standards. For 8%, the assessment was unknown^.
- Concerns of boundary breach or ineffective communication were most likely to be assessed as below expected standards.
About this analysis
This report is based on our analysis of the underlying themes in 3,089 complaints to regulators and compensation claims for Avant member doctors from all specialties. These were finalised between July 2019 and June 2020.
There were 766 claims involving professionalism in doctor- patient interactions. These were classified as those for which this was the main or a contributing factor. For the purposes of identifying relevant claims, inclusion categories were defined as:
- Disrespect: Claims related to a doctor's lack of respect or consideration for a patient's values, preferences, autonomy, expressed needs, comfort and/or quality of life and/or disrespectful communication with a patient.
- Ineffective communication: Claims related to ineffective communication with a patient about their health or care. Includes the doctor not communicating in a way the patient understands (e.g. using jargon), not adjusting communication to suit the patient's communication needs, and/or not communicating appropriately with the patient (e.g. making irrelevant comments).
- Boundary breach: Claims related to a doctor breaching sexual or non-sexual boundaries, including inappropriate manner, behaviour or comments to a patient, and/or threatening, bullying, or violence towards a patient (including assault). Also includes inappropriate dealings with a patient or their family (e.g. business dealings).
- Lack of emotional support: Claims related to a lack of emotional support for the patient in terms of addressing their anxiety, concerns and/or fears regarding their health and care.
For any queries please contact us at research@avant.org.au
More resources
For articles, factsheets, case studies and other resources on a range of topics, including the following, visit the Avant Learning Centre.
- Communication fundatmentals eLearning course
- Boundary issues factsheet
- Managing patient expectations factsheet
- Managing difficult patients factsheet
- Managing differences: care and compliance factsheet
- How to end the doctor-patient relationship factsheet
- Breaking bad news to patients factsheet
- Observers: protection and guidance factsheet
- Debra R. The patient-physician relationship and its implications for malpractice litigation. Journal of Health Care Law & Policy. 2006;9:304-314.
- Hickson GB, Entman SS. Physician practice behavior and litigation risk: evidence and opportunity. Clinical Obstetrics and Gynecology. 2008;51(4):688-699.
- Smith DD, Kellar J, Walters EL, et al. Does emergency physician empathy reduce thoughts of litigation? A randomised trial. Emergency Medicine Journal. 2016;33:548–552.
- Cave J, Dacre J. Dealing with complaints. British Medical Journal. 2008;336(7639):326-328.
Disclaimers
IMPORTANT: Avant routinely codes information collected in the course of assisting member doctors in medico-legal matters into a standardised, deidentified dataset. This retrospective analysis was conducted using this dataset. The findings represent the experience of these doctors in the period of time specified, which may not reflect the experience of all doctors in Australia. This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision-making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published (November 2020).
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