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Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient Complaints and Malpractice Risk. JAMA. 2002;287(22):2951–2957. doi:10.1001/jama.287.22.2951
Author Affiliations: Departments of Pediatrics (Drs Hickson and Bost), Preventive Medicine (Dr Federspiel), Medicine (Dr Pichert), and Social Work (Ms Miller), and Office of Patient Affairs (Ms Gauld-Jaeger), Vanderbilt University School of Medicine, Nashville, Tenn.
Context A small number of physicians experience a disproportionate share of
malpractice claims and expenses. If malpractice risk is related in large measure
to factors such as patient dissatisfaction with interpersonal behaviors, care
and treatment, and access, it might be possible to monitor physicians' risk
of being sued.
Objective To examine the association between physicians' patient complaint records
and their risk management experiences.
Design, Setting, and Participants Retrospective longitudinal cohort study of 645 general and specialist
physicians in a large US medical group between January 1992 and March 1998,
accounting for 2546 physician-years of care.
Main Outcome Measures Computerized records of all unsolicited patient complaints were recorded
by the medical center's patient affairs office, coded to characterize the
nature of the problem and alleged offender, and compared with each physician's
risk management records for the same period.
Results Both patient complaints and risk management events were higher for surgeons
than nonsurgeons. Specifically, 137 (32%) of the 426 nonsurgeons had at least
1 risk management file compared with nearly two thirds (137 [63%] of 219)
of all surgeons (χ21= 54.7, P<.001). Both complaint and risk management data were positively
correlated with physicians' volume of clinical activity. Logistic regression
revealed that risk management file openings, file openings with expenditures,
and lawsuits were significantly related to total numbers of patient complaints,
even when data were adjusted for clinical activity. Predictive concordance
of specialty group, complaint count, clinical activity, and sex for risk management
file openings was 84%; file openings with expenditures, 83%; lawsuits, 81%;
and multiple lawsuits, 87%.
Conclusions Unsolicited patient complaints captured and recorded by a medical group
are positively associated with physicians' risk management experiences.
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