Original article
What Patient Attributes Are Associated With Thoughts of Suing a Physician?

https://doi.org/10.1016/j.apmr.2007.02.007Get rights and content

Abstract

Fishbain DA, Bruns D, Disorbio JM, Lewis JE. What patient attributes are associated with thoughts of suing a physician?

Objective

To address a neglected research area: the attributes of rehabilitation patients associated with “thoughts of suing a physician” (S-MD).

Design

The S-MD statement “I am thinking about suing one of my doctors” was administered to 2264 people, along with the Battery for Health Improvement (BHI 2). Items predictive of S-MD were identified.

Setting

Acute physical therapy, work hardening programs, chronic pain programs, physician offices, and vocational rehabilitation programs.

Participants

Participants included 777 rehabilitation patients and 1487 nonpatient community-dwellers.

Interventions

Not applicable.

Main Outcome Measures

We used a multivariate analysis of variance to determine which of the 18 BHI 2 scales predicted the S-MD statement. Items from the scales found to be predictive, plus other variables, were then used in a chi-square analysis that compared people who wished to sue with those who did not. We then used a stepwise regression analysis with significant items from the prior analyses to build a model for predicting a potential S-MD patient.

Results

The highest percentage (11.5%) of patients affirming the S-MD statement were those involved in workers’ compensation and personal injury litigation, compared with only 1.9% of community-living subjects. Stepwise regression of BHI 2 variables produced a 13-variable model explaining 38.04% of the variance. A logistic regression of demographic variables (eg, education, ethnicity, litigiousness) explained 20% of the variance.

Conclusions

Anger (P<.001), mistrust (P<.001), a focus on compensation (P<.001), addiction (P<.001), severe childhood punishments (P<.001), having attended college (P<.001), and other patient variables were associated with thoughts of suing a physician.

Section snippets

Methods

The statement “I am thinking about suing one of my doctors” (S-MD), which was the focus of this study, was 1 of 600 questions and/or statements in the Battery for Health Improvement research version (BHI-R), and the Battery for Health Improvement 2 (BHI 2),22 which is a shorter version of the BHI-R. We administered the BHI-R to subjects in this study and scored the BHI 2 scales from the BHI-R.

The BHI 2 is a standardized test intended for use in the psychologic assessment of medical patients and

Results

Table 1 shows the percentage of the reference group samples who said that they were thinking about suing one of their treating physicians. The highest percentage (11.5%) was in the sample of patients who were workers’ compensation or injury litigation cases.

Discussion

This is the first study known to us that has addressed the question of which patient attributes are associated with a wish to initiate a malpractice lawsuit against his/her physician. First, we attempted to determine the prevalence among both rehabilitation patients and community-dwellers of a wish to sue a physician. That wish was present in a range from 1.9% to 2.8% in the community sample and from 4.3% to 11.5% in the patient sample. The highest prevalence was in the workers’ compensation

Information From Dichotomous Variables

The BHI 2 dichotomous variables that yielded the most significant ORs (see table 4) were: forced to see MD don’t trust (OR=15.54); angry with MD (OR=10.09); MDs only want money (OR=9.29); hearing voices (OR=8.73); somebody owes me for my pain and suffering (OR=6.68); suicidal ideation (OR=5.78); addiction to prescription medication (OR=5.03); and thoughts of killing people (OR=4.93).

The highest ORs for demographic and non-BHI 2 variables (see table 5) were: MDs get rich off my suffering

Conclusions

In some patient groups, thoughts of suing a physician are not uncommon, and this has been determined to be associated with some patient attributes. While events that occur in a medical setting, such as poor outcomes or medical errors, probably contribute substantially to thoughts of suing, research shows that only a small percentage of patients involved in alleged medical errors resort to litigation. The presence of psychologic risk factors may influence who sues and who does not. Future

Acknowledgments

We thank the staff of Pearson Assessments for its invaluable help in collecting the data. Pearson Assessments was involved in data collection in the original study, in which data were gathered for the purpose of developing the psychologic scale. Pearson Assessments, however, had no role in the design or statistical analysis of this study, nor did Pearson Assessments provide any funding, support, or input. This study’s findings were the result of a reanalysis of the data after the original study

References (28)

  • N. Ambady et al.

    Surgeons’ tone of voice: a clue to malpractice history

    Surgery

    (2002)
  • M. Gorney

    Anger as the root cause of malpractice claims

    Clin Plast Surg

    (1999)
  • R.J. Rubin et al.

    How much does defensive medicine cost?

    J Am Health Policy

    (1994)
  • Medical malpractice litigation raises health-care cost, reduces access, and lowers quality of care

    J Med Pract Manage

    (2004)
  • R. Penchansky et al.

    Initiation of medical malpractice suits: a conceptualization and test

    Med Care

    (1994)
  • T.A. Brennan et al.

    Relation between negligent adverse events and the outcomes of medical-malpractice litigation

    N Engl J Med

    (1996)
  • A.R. Localio et al.

    Relation between malpractice claims and adverse events due to negligenceResults of the Harvard Medical Practice Study III

    N Engl J Med

    (1991)
  • G. Neale

    Clinical analysis of 100 medicolegal cases

    BMJ

    (1993)
  • P.J. Moore et al.

    Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions

    West J Med

    (2000)
  • D. Karp

    Why patients sue for malpracticeWhat do patients think of your practice?

    Mich Med

    (1994)
  • W. Levinson et al.

    Physician-patient communicationThe relationship with malpractice claims among primary care physicians and surgeons

    JAMA

    (1997)
  • P.A. Sommers

    Minimizing malpractice risk: a patient approach

    Group Pract J

    (1987)
  • J.R. Rose

    Patient survey: malpracticeGood news: malpractice is not on their minds

    Med Econ

    (1995)
  • W. Levinson

    Physician-patient communicationA key to malpractice prevention

    JAMA

    (1994)
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    This study was conducted without external funding. The study, however, reanalyzed data from a previous study that was funded and supported by Pearson Assessments.

    A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon 1 or more of the authors. Bruns and Disorbio receive Battery for Health Improvement 2 royalties.

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