U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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RISK MANAGEMENT

Risk Management and Medical Liability

A Manual for Indian Health Service and Tribal Health Care Professionals
(Second Edition)
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Section Two: Underlying Influences That Often Lead to Claims of Malpractice

Patients will file malpractice claims for a variety of reasons and pressures. Often, many issues are involved in an individual’s decision to file a claim. The following list summarizes some of the major influences identified both in the literature and from experts in the field.

Medical Injury, Poor Result, or Adverse Outcome
Adverse outcomes inevitably occur from time to time as a result of medical care, as many of the things we do are risk prone. There must be some form of injury identified if a malpractice legal action is contemplated. The injury need not be permanent or physical, but it is often more difficult for a claimant to seek damages solely for “pain and suffering” without a more tangible physical injury.

Provider Errors/Negligence
Provider errors should never be covered up or denied, even at the risk of initiating a malpractice claim. The goal of health care quality assurance and risk management programs is to prevent provider errors and guard against negligence, not to suppress it when it occurs.

Unrealistic Public Expectations of Medical Outcomes
The lay public often has expectations of medical outcomes that do not coincide with actual success rates. Providers who give false hopes or promise a cure add to this problem. Adequate informed consent and honest communication are always essential.

Litigious Patients/Society
There is no question we live within a society and culture where looking for someone to blame is the norm. It is a fact of life that some individuals will grasp at opportunities to seek compensation for borderline or nuisance reasons. A few lawyers actively pursue potential malpractice cases.

Weak Doctor-Patient Trust
If there is no trust in the doctor-patient relationship, the patient will be more likely to question both the competence and recommendations of the health care provider when an adverse outcome does occur. Trust must be earned, and it begins with the establishment of a good patient-physician relationship. Patients rarely bring tort action against providers they trust and like or perceive are trying their best to serve them.

Patient Depersonalization
Patients deserve, and usually demand our respect. When patients are treated without dignity, their satisfaction level will obviously plummet. As a result, patients will not be as understanding when adverse outcomes occur, and may be more likely to file compensation claims out of anger or embarrassment.

Certain Patterns of Professional Behavior
In addition to demanding respect, patients want to feel comfortable in the presence of their health care provider. Brash speech, off-colored humor, rough handling, and other unprofessional behavior detract from a feeling of security and confidence. No patient could claim negligence because of such behavior in and of itself. However, when an adverse outcome does occur, patients may be more likely to seek action against a provider who has consistently been perceived as being unprofessional or uncaring.

Unresolved Misunderstandings
Poor communication results in many misunderstandings and misguided expectations. Physicians who do not take the time to explain the diagnosis, treatment, precautions, and prognosis run significant risk of having an ill-informed, distrustful, and disgruntled patient.

Many of these adverse influences can be favorably modified by conscientious efforts on the part of the health care team. A professional and compassionate patient-provider relationship is the cornerstone of any risk management program. This very special relationship is further explored in the next section.


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