Ambady Nalini, Laplante Debi, Nguyen Thai, Rosenthal Robert, Chaumeton Nigel, Levinson Wendy
Department of Psychology, Harvard University, Boston, Mass, USA.
Surgery. 2002 Jul;132(1):5-9. doi: 10.1067/msy.2002.124733.
Interpersonal aspects of care, such as the communication behaviors of physicians, are often cited as central to patients' decisions to initiate malpractice litigation. Relatively little is known, however, about the impact of the communication behaviors of surgeons. In the current study, we investigated the relationship between judgments of surgeons' voice tone and their malpractice claims history.
We examined the relationship between surgeons' voice tone during routine office visits and their history of malpractice claims. Surgeons were audiotaped while speaking to their patients during office visits, and very brief samples of the conversations were rated by coders blind to surgeons' claims status. Two 10-second clips were extracted for each surgeon from the first and last minute of their interactions with 2 different patients. Several variables were rated that assessed warmth, hostility, dominance, and anxiety from 10-second voice clips with content and 10-second voice clips with just voice tone.
Controlling for content, ratings of higher dominance and lower concern/anxiety in their voice tones significantly identified surgeons with previous claims compared with those who had no claims (odds ratio [OR] 2.74, 95% confidence interval [CI] 1.16 to 6.43 for dominance; OR 0.46, 95% CI 0.21 to 1.01 for concern/anxiety).
Surgeons' tone of voice in routine visits is associated with malpractice claims history. This is the first study to show clear associations between communication and malpractice in surgeons. Specific types of affect associated with claims can be judged from brief audio clips, suggesting that this method might be useful in training surgeons.
医疗护理中的人际因素，如医生的沟通行为，常被认为是患者决定提起医疗事故诉讼的核心因素。然而，对于外科医生沟通行为的影响，我们了解得相对较少。在本研究中，我们调查了外科医生语调判断与他们的医疗事故索赔历史之间的关系。
我们研究了外科医生在常规门诊就诊时的语调与他们的医疗事故索赔历史之间的关系。在门诊就诊期间，外科医生与患者交谈时进行录音，由对医生索赔状态不知情的编码员对对话的简短样本进行评分。从每位外科医生与2名不同患者互动的第一分钟和最后一分钟中各提取两个10秒的片段。对几个变量进行评分，这些变量从带有内容的10秒语音片段和仅带有语调的10秒语音片段中评估温暖度、敌意、主导性和焦虑程度。
在控制内容的情况下，与无索赔记录的外科医生相比，语调中较高的主导性和较低的关切/焦虑评分显著识别出有既往索赔记录的外科医生（主导性的优势比[OR]为2.74，95%置信区间[CI]为1.16至6.43；关切/焦虑的OR为0.46，95%CI为0.21至1.01）。
外科医生在常规就诊中的语调与医疗事故索赔历史相关。这是第一项显示外科医生沟通与医疗事故之间存在明确关联的研究。与索赔相关的特定情感类型可以从简短的音频片段中判断出来，这表明这种方法可能对外科医生培训有用。
