Levinson W, Roter D L, Mullooly J P, Dull V T, Frankel R M
Department of Medicine, Oregon Health Sciences University, Portland, USA.
JAMA. 1997 Feb 19;277(7):553-9. doi: 10.1001/jama.277.7.553.
To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons.
Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician.
One hundred twenty-four physician offices in Oregon and Colorado.
Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (> or =2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty.
Audiotape analysis using the Roter Interaction Analysis System.
Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons.
Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.
确定与初级保健医生和外科医生医疗事故历史相关的特定沟通行为。
通过每位医生10次常规门诊的录音，比较“有索赔记录”与“无索赔记录”医生的沟通行为。
俄勒冈州和科罗拉多州的124个医生办公室。
59名初级保健医生（普通内科医生和家庭医生）以及65名普通外科医生和骨科医生及其患者。根据保险公司记录，医生被分为无索赔组或索赔组（终身索赔≥2次），并按执业年限和专业进行分层。
使用罗特互动分析系统进行录音分析。
在初级保健医生中发现了无索赔记录和有索赔记录医生在沟通行为上的显著差异，但在外科医生中未发现。与有索赔记录的初级保健医生相比，无索赔记录的初级保健医生使用更多的定向陈述（向患者说明预期情况和就诊流程），更多地大笑和使用幽默，并且倾向于使用更多的促进性语言（征求患者意见、检查理解情况并鼓励患者交谈）。无索赔记录的初级保健医生在常规门诊中花费的时间比有索赔记录的初级保健医生更长（平均18.3分钟对15.0分钟），就诊时间长短对预测索赔状态有独立影响。初级保健医生的多变量模型将索赔状态的预测准确率提高到高于随机水平57%（90%置信区间，33%-73%）。多变量模型并未显著提高对外科医生索赔状态的预测。
有医疗事故索赔记录和无索赔记录的初级保健医生在常规医患沟通方面存在差异。相比之下，该研究未发现沟通行为能够区分有索赔记录和无索赔记录 的外科医生。该研究确定了与初级保健医生较少医疗事故索赔相关的特定且可传授的沟通行为。医生在寻求改善沟通和降低医疗事故风险时可利用这些发现。医疗事故保险公司可利用此信息指导初级保健医生的医疗事故风险预防和教育，但不应假定向其他专业群体传授类似行为是合适的。
