The Predisposition to File Claims: The Patient's Perspective

The crisis is still growing. Contrary to the belief that the peak of 1973–75 is past, claims are costing more than ever. St. Paul Fire and Marine Insurance Company (the nation's largest malpractice insurer) estimates that while the actual number of suits may be dropping, cost per exposure is increasing dramatically — up 63 percent between 1976 and 1981. St. Paul and Marine Insurance, Perspective Special #1 (February 1981).

See, e.g., Davis N.M. , Medication Errors (George F. Stickley, Publisher, Philadelphia, Penna.) (1981); Furrow B.R. , Iatrogenesis and Medical Error: The Case for Medical Malpractice, Law, Medicine & Health Care 9(5): 4–7 (October 1981).

Canterbury V. Spence, 464 F.2d 722 (D.C. Cir.), cert. denied, 409 U.S. 1064 (1972).

Wilkinson V. Harrington (Wilkinson v. Vesey), 243 A.2d 745 (R.I. 1968).

Miller L.J. , Informed Consent, Parts I-IV, Journal of the American Medical Association 244(15): 2100–03 (November 7, 1980); 244(20): 2347–50 (November 21, 1980); 244(22): 2556–58 (December 5, 1980); 244(23): 2661–62 (December 12, 1980).

See Vaccarino J.M. , Malpractice: The Problem in Perspective, Journal of the American Medical Association 238(3): 861–63 (August 22, 1977); Ladenburger M. , quoted in Occurence 3(6): 4 (1983).

Press I. , Report to the Department of Risk Management, Jackson Memorial Hospital, Miami, Fla. (1982).

St. Paul Fire & Marine Ins. Co., Property and Liability Division Report (1982) (claims per physician were 3.4 percent; hospital claims per exposure were 2.5 percent).

Steel K. , Iatrogenic Illness on a General Medical Service at a University Hospital, New England Journal of Medicine 304(11): 638–42 (March 12, 1981).

Felsteiner W. Abel R. Sarat A. , The Emergence and Transformation of Disputes: Naming, Blaming, Claiming, Law and Society Review 15(3 & 4): 631–54 (1980/1981).

Horsley J. , Turning Off the Patient's Family Can Turn On a Lawsuit, Medical Economics, 56: 119, 129 (January 22, 1979).

Lander L. , Why Some People Seek Revenge Against Doctors, Psychology Today 12(2): 88, 90–91 (July 1978).

Id. at 91.

Woolley F.R. , Research Note: The Effects of Doctor-Patient Communication on Satisfaction and Outcome of Care, Social Science and Medicine 12A(2): 123, 127 (March 1978).

Id.

Cay E.L. , Patients’ Assessment of the Result of Surgery for Peptic Ulcer, Lancet, pp. 29, 30 (January 4, 1975).

Segall A. Burnett M. , Patient Evaluation of Physician Role Performance, Social Science and Medicine 14A(4): 269, 277 (July 1980).

Ben-Sira Z. , The Function of the Professional's Affective Behavior in Client Satisfaction: A Revised Approach to Social Interaction Theory, Journal of Health & Social Behavior 17(1): 3–11 (March 1976).

Larson D. Rootman I. , Physician Role Performance and Patient Satisfaction, Social Science and Medicine 10(1): 29 (January 1976) (emphasis added).

Taylor P.W. , Development and Use of a Method of Assessing Patient Perception of Care, Hospital and Health Services Administration 26: 89–99 (Winter 1981).

Id.

Waitzkin H. Stoeckel J. , Information Control and the Micropolitics of Health Care: Summary of an Ongoing Research Project, Social Science and Medicine 10(6): 263, 264 (June 1976).

Id.

Bain D.J. , Doctor-Patient Communication in General Practice Consultations, Medical Education 10(2): 125–31 (March 1976).

Golden J. Johnston G. , Problems of Distortion in Doctor-Patient Communications, Psychiatry in Medicine 1: 127–49 (1970).

Hulka B. , Communication, Compliance, and Concordance Between Physicians and Patients With Prescribed Medications, American Journal of Public Health 66(9): 847–53 (September 1976); Sackett D.L. Snow J. , The Magnitude and Measurement of Compliance, in Compliance in Health Care ( Haynes R. , eds.) (Johns Hopkins University Press, Baltimore, Md.) (1979).

Norell S.E. , Accuracy of Patient Interviews and Estimates by Clinical Staff in Determining Medication Compliance, Social Science and Medicine 15E(1): 57, 59 (February 1981).

Id.

A study I recently completed in three hospitals in South Bend, Indiana, revealed that hostelry items constitute approximately 45 percent of total complaints, while 25 percent of the patients complained about quality of interaction with physicians and nurses.

Marks B. , The Suing of America (Sea-view, New York, N.Y.) (1981) at 21.

Eisenberg L. , Disease and Illness: Distinction Between Professional and Popular Ideas of Sickness, Culture, Medicine, and Psychiatry 1(1): 9–23 (April 1977) at 9.

Lambert W.E. , The Effect of Increased Salience of a Membership Group on Pain Tolerance, Journal of Personality 38: 350–57 (1960).

Zborowski M. , Cultural Components in Responses to Pain, Journal of Social Issues 8: 16–30 (1952).

Zola I.K. , Culture and Symptoms: An Analysis of Patients’ Presenting Complaints, American Sociological Review 31(5): 615, 630 (October 1966).

See generally Suchman E.A. , Stages of Illness and Medical Care, Journal of Health and Human Behavior 6(3): 114–28 (Fall 1965); Freidson E. , Patients’ Views of Medical Practice: A Study of Subscribers to a Prepaid Medical Plan in the Bronx (Russell Sage Foundation, New York, N.Y.) (1961).

Alpert J. , A Month of Illness and Health Care Among Low-Income Families, Public Health Report 82(8): 705, 713 (August 1969); White K. , The Ecology of Medical Care, New England Journal of Medicine 265(18): 885, 890–91 (November 2, 1961).

Zola I.K. , Studying the Decision to See a Doctor, Advances in Psychosomatic Medicine 8:216–36 (1972).

Press, I., Urban Illness: Physicians, Curers, and Dual Use in Bogotáa, Journal of Health and Social Behavior 19:209–18 (1969). See Good M.J. Good B. , Patient Requests in Primary Care Clinics, in Clinically Applied Anthropology ( Crisman N. Haynes T. , eds.) (D. Reidel, Dordrecht, Holland) (1982) at 292.

Kleinman A. , Explanatory Models in Health Care Relationships (National Council for International Health: Health of the Family, Washington, D.C.) (1975) at 159–72.

See Press I. , Problems in the Definition and Classification of Medical Systems, Social Science and Medicine 14B(1): 45–57 (February 1980) (discussing the difference between popular and folk medical beliefs and systems). See also Weidman H. , “Falling-Out“: A Diagnostic and Treatment Problem Viewed from a Transcultural Perspective, Social Science and Medicine 13B; 95–112 (1979) (southern black “falling out”); Cohn L. , Culture, Disease, and Stress Among Latino Immigrants: RIIES Special Study (Research Institute on Immigration and Ethnic Studies, Washington, D.C.) (1979) (hypertension beliefs); Snow L. , Folk Medical Beliefs and Their Implications for Core of Patients, Annals of Internal Medicine 84:82–96 (1974) (black American medical concepts); Blumhagen D. , Hyper-Tension: A Folk Illness with a Medical Name, Culture, Medicine and Psychiatry 4(3): 197–227 (September 1980) (hypertension beliefs); Helman C.G. , “Feed a Cold, Starve a Fever“—Folk Models of Infection in an English Suburban Community and Their Relation to Medical Treatment, Culture, Medicine and Psychiatry 2(2): 107–37 (June 1978) (non-ethnic beliefs about cold and fever treatment).

See, e.g., Koos E. , The Health of Regionville (Columbia University Press, New York, N.Y.) (1954); Hinkle L.E. , An Examination of the Relation Between Symptoms, Disability, and Serious Illness in Two Homogeneous Groups of Men and Women, American Journal of Public Health 50(9): 1327–36 (September 1960); Rosenblatt D. Suchman M. , Blue Collar Attitudes and Information Toward Health and Illness, in Blue Collar World: Studies of the American Worker ( Shostak A. Gornberg W. , eds.) (Prentice-Hall, Englewood Cliffs, N.J.) (1964); Duff R. Hollingshead A. , Sickness and Society (Harper & Row, New York, N.Y.) (1968); A Month of Illness and Health Care Among Low-Income Families, supra note 36; Kosa J. , Poverty and Health: A Sociological Analysis (Harvard University Press, Cambridge, Mass.) (1969); Rosenstock I. Kirscht J. , Why People Seek Healtk Care, in Health Psychology: A Handbook: Theories, Applications, and Challenges to the Health Care System ( Stone G.C. , eds.) (Jossey-Bass, Inc., San Francisco, Calif.) (1979).

Fabrega H. Jr. , Disease and Social Behavior (MIT Press, Cambridge, Mass.) (1974) at 247–56; Foster G. , Disease Etiologies in Non-Western Medical Systems, American Anthropologist 78(4): 773–82 (December 1976).

Press I. , Urban Folk Medicine: A Functional Overview, American Anthropologist 80(1): 71–84 (March 1978).

Lewis G. , Cultural Influences on Illness Behavior: A Medical Anthropologist Approach, in The Relevance of Social Science for Medicine ( Eisenberg L. Kleinman A. , eds.) (D. Reidel, Dordrecht, Holland) (1981) at 156.

Cassell E.J. , The Nature of Suffering and the Goals of Medicine, New England Journal of Medicine 306(11): 639, 642 (March 18, 1982).

Waitzkin J. , Medicine, Superstructure, and Micropolitics, Social Science and Medicine 13A(6): 601–09 (November 1979).

Ries R. , Psychiatric Consultation-Liaison Service: Patients’ Requests, Functions, General Hospital Psychiatry 2(3): 204–212 (September 1980).

Cassell , supra note 45, at 639.

Bain , supra note 24.

Platt F. McMath J. , Clinical Hypocompetence: The Interview, Annals of Internal Medicine 91(6): 898–902 (December 1979).

Twaddle A. , Sickness and the Sickness Cancer: Some Implications, in The Relevance of Social Science for Medicine, supra note 44, at 124. For further discussion of the double bind, see Bloor M. Horobin G. , Conflict and Conflict Resolution in Doctor/Patient Interactions, in Sociology of Medical Practice ( Cox C. Mead A. , eds.) (Collier-MacMillan, London, Eng.) (1975) at 271–84; Friedson , supra note 35.

Yoder L. Jones S. , The Family of the Emergency Room Patient as Seen through the Eyes of the Nurse, International Journal of Nursing Studies 19: 29–36 (1982).

DiMatteo M. Hays R. , Social Support and Serious Illness, in Social Networks and Social Support ( Gottlieb B. , ed.) (Sage Publications, Beverly Hills, Calif.) (1981) at 117–48; Pisarcik G. , Psychiatric Nurses in the Emergency Room, American Journal of Nursing 79(7): 1264–66 (July 1979).

Horsley , supra note 11.

See Boyle C.M. , Differences Between Patients’ and Doctors’ Interpretations of Some Common Medical Terms, in Sociology of Medical Practice, supra note 51, at 299–308.

Press I. , Witch Doctor's Legacy: Some Anthropological Implications for the Practice of Clinical Medicine, in Clinically Applied Anthropology, supra note 38, at 179–98 (suggesting relatively simple changes in physicians’ style, and suggesting that folk healers have been successful by fitting their paradigms to the social/emotional needs of patients and, in particular, by their overwhelming attention to the patient's illness).

Platt McMath , supra note 50.

See generally Cartwright A. , Patients and Their Doctors (Atherton Press, New York, N.Y.) (1967); Davis M.S. , Variations in Patients’ Compliance with Doctors’ Advice: Empirical Analysis of Patterns of Communication, American Journal of Public Health 58(2); 274–99 (February 1968); Golden Johnston , supra note 25; Barnlund, D.C., The Mystification of Meaning: Doctor-Patient Encounters, Journal of Medical Education 51(9): 716–25 (September 1976); Wachsman P. , The Significance of Reducing Malpractice Claims, Medical Malpractice Cost Containment Journal 1(1): 40–47 (Spring 1979); Hauser S. , Physician-Patient Relationships, in Social Contexts of Health, Illness and Patient Care ( Mishler E. , eds.) (Cambridge University Press, Cambridge, England) (1981) at 5–140; Byrne P. Long B. , Doctors, Talking to Patients (Her Majesty's Stationery Office, London) (1976); Larson Rootman , supra note 19.

Kurella S. , The Social Needs of Patients and Their Satisfaction with Medical Care: A Survey of Medical Inpatients in the County Hospitals of the German Democratic Republic, Social Science and Medicine 13A(6): 737–42 (November 1979) (emphasis added).

Kleinman A. Eisenberg L. Good B. , Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross Cultural Research, Annals of Internal Medicine 88(2): 251–58 (February 1978).

Lazare A. , Studies on a Negotiated Approach to Patienthood, in The Doctor-Patient Relationship in the Changing Health Scene ( Gallagher E. , ed.) (National Institutes of Health, Washington, D.C.) (1978) at 119–39.

Personal communication with directors of Holy Cross Shared Services, a hospital management organization.

Directed by the National Joint Practice Commission, the study involved four hospitals. See Guidelines for Establishing Joint or Collaborative Practice in Hospitals (National Joint Practice Commission, Chicago, Ill.) (1981). See also Browning G. Marino P. , Joint Practice: A Rural Hospital Can Make It Work, Nursing Management 14(3): 22, 25 (March 1983).

Patient committees may be used in handling, in addition to identifying, complaints. Seifert Milton Dr. Jr. , a family practitioner in Excelsior, Minnesota, formed an “advisory council”from among his patients, apparently with such empathy and success that Seifert's insurance company has reduced his malpractice premium by 10 percent (personal communication with author).