Why doctors get sued, and how to predict which ones will (Medical Leadership Group)

by Phil Dourado January 21, 2008

Blink - Malcolm GladwellFrom Malcolm Gladwell's book Blink - The Power of Thinking without Thinking:

"Recently the medical researcher Wendy Levinson recorded hundreds of conversations between a group of physicians and their patients. Roughly half of the doctors had never been sued. The other half had been sued at least twice, and Levinson found that just on the basis of those conversations, she could find clear differences between the two groups.

"The surgeons who had never been sued spent more than three minutes longer with each patient than those who had been sued did (18.3 minutes versus 15 minutes). They were more likely to make “orienting” comments, such as “First I’ll examine you, and then we will talk the problem over” or “I will leave time for your questions” – which help patients get a sense of what the visit is supposed to accomplish and when they ought to ask questions. They were more likely to engage in active listening, saying things such as “Go on, tell me more about that,” and they were far more likely to laugh and be funny during the visit.

"Interestingly, there was no difference in the amount or quality of information they gave their patients; they didn’t provide more details about medication of the patient’s condition. The difference was entirely in how they talked to their patients.

"It’s possible, in fact, to take this analysis even further. The psychologist Nalini Ambady listened to Levinson’s tapes, zeroing in on the conversations that had been recorded between just surgeons and their patients. For each surgeon, she picked two patient conversations. Then, from each conversation, she selected two ten-second clips of the doctor talking, so her slice was a total of forty seconds.

"Finally, she “content-filtered” the slices, which means she removed the high-frequency sounds from speech that enable us to recognize individual words. What’s left after content-filtering is a kind of garble that preserves intonation, pitch and rhythm but erases content. Using that slice – and that slice alone – Ambady did a Gottman-style analysis. She had judges rate the slices of garble for such qualities as warmth, hostility, dominance, and anxiousness, and she found that by using only those ratings, she could predict which surgeons got sued and which ones didn’t."

There seem to me to be a whole range of leadership issues bundled into that extract from Gladwell's book, including:

Financial and legal leadership:

Chief Executives of hospitals and medical centres need to know this and take action on it to reduce the number of legal actions their unit(s) inadvertently generate and have to defend.

Reputation management:

As above. Within professional doctors' associations it also seems to me there is a responsibility to take the lead on this issue to improve the reputation of their profession and its members. The most obvious route for professional associations to take the lead on is educating their members

Respect, Power and Trust:

Just as the most effective leadership is based on mutual respect and trust, not on a power or knowledge imbalance, the same applies to the best medical treatment. The same can obviously be said for empathy and listening Some doctors, like some leaders, assume their role is as an authority imparting information, instruction and wisdom. Listening clearly needs to come first.

What do you think? Is this an issue for your organization (doctors being sued)? If so, what is your organization doing to take the lead in dealing with it? Or are there other issues this extract raises that you want to contribute an insight on that may be useful to other members of this group? You can use the 'add comment' button, below. Thanks.


I've attached a longer Word document that goes into this in more detail, from Gladwell's book Blink. You can read it by clicking on the filename, below. It's an 'action document' - 'read then do' - with recommendations at the end. Because The Hub is not just a talking shop. It's about 'action learning' (doing as well as reading and commenting).


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