—Dr Balon raises the possibility that our findings of the relationship between communication and medical malpractice might be different in the era of managed care in which the average length of visits is shorter. While the actual number of minutes in a visit may be shorter in 1997 than in 1992 when the visits were taped, we do not expect this would have changed the significant finding that primary care physicians who had been sued had shorter visits than physicians without a history of prior claims. Furthermore, most physicians report that they do not believe that the audiotaping process changed their communication style,1 and we think it is unlikely that they talked longer in this study than during normal visits.Dr Frank suggests that the study findings might be different in the inpatient setting or with particular types of patients such as postoperative patients or patients with chronic disease.
Levinson W. Malpractice Claims and Physicians' Communication Patterns-Reply. JAMA. 1997;277(21):1682. doi:10.1001/jama.1997.03540450038030