June 14, 2002

Vanderbilt team outlines malpractice risk in JAMA

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Dr. Gerald Hickson is leading the malpractice study at Vanderbilt University Medical Center.

Vanderbilt team outlines malpractice risk in JAMA

A team of Vanderbilt University Medical Center researchers has established a basis for closer measurement of physicians’ risk for malpractice suits. The study, appearing in the June 12 issue of the Journal of the American Medical Association, points the way to interventions that may help lower doctors’ risk of suits.

The study, led by Dr. Gerald B. Hickson, professor and vice chair of Pediatrics, suggests that inability to establish rapport with patients is a root cause of increased risk of malpractice suits. In all, the study identifies three factors that together allow new accuracy in the prediction of malpractice suits: unsolicited patient complaints, higher clinical work volumes, and whether the practice is surgical (higher risk for suits) or non-surgical (lower risk for suits).

Over the past 15 years Hickson and various collaborators have studied what motivates patients to bring malpractice suits, which types of patients are most apt to sue and which types of doctors are at greatest risk for suits.

“Previous research has found that neither technical competence nor patient severity is a significant determinant of the risk of malpractice suit,” Hickson said. “All doctors have patients who experience adverse events. What sends people to lawyers are perceptions, not necessarily medical facts.”

It turns out that year in and year out the same doctors attract a disproportionate share of malpractice suits, with 6 percent of doctors attracting approximately 40 percent of suits. Lack of information has left physicians prone to misconceptions about their relative risk for suits. The study addresses this information deficit, firmly establishing patient complaints as an identifier for malpractice suit risk.

Studying Vanderbilt’s six years’ worth of unsolicited patient complaints, Hickson found that 10 percent of doctors generated 50 percent of patient complaints. Checking the distribution of complaints against the distribution of malpractice suits turned up obvious connections. As one example of findings in the new study, surgeons with two or more malpractice suits (or pre-trial settlements) had nearly six times as many patient complaints as their colleagues with no law suits (at the mean, 35.1 versus 6.1 complaints).

The study uses data from six years of practice by 645 general and specialist physicians at Vanderbilt, including unsolicited patient complaints, malpractice suits, and risk management reports (hospital files generated when faculty or staff notice a potential liability). These data are examined against the backdrop of each doctor’s specialty area, clinical work volume and gender.

Hickson and his research partners have designed a program to help medical centers identify and work with doctors who experience high numbers of complaints. They created a method to assign risk scores to doctors, and a program to educate high-risk doctors. The system is being used at 11 medical centers, ranging from major academic health centers to regional hospitals in rural Arkansas. The system was recently adopted for use at Vanderbilt. A subsequent study will evaluate the effectiveness of the program’s interventions to lower risk of suits.

Hickson’s study partners included Charles F. Federspiel, Ph.D., professor of Biostatistics, Emeritus; Jean Gauld-Jaeger, director of Patient Affairs; Cynthia S. Miller, MSSW, social worker; Preston Bost, Ph.D, now on the psychology faculty at Wabash College.