THE DOCTOR-PATIENT-RELATIONSHIP AND MALPRACTICE - LESSONS FROM PLAINTIFF DEPOSITIONS

Background: The current literature does not provide an answer to the q uestion, ''What prompts patients to sue doctors or hospitals?'' Not al l adverse outcomes result in suits, and threatened suits do not always involve adverse outcomes. The exploration of other factors has been h ampered by the lack of a methodology to contact plaintiffs and elicit their views about their experience in delivered health care. This stud y employed the transcripts of discovery depositions of plaintiffs as a source of insight into the issues that prompted individuals to file a malpractice claim. Methods: This study is a descriptive series review of a convenience sample of 45 plaintiffs' depositions selected random ly from 67 depositions made available from settled malpractice suits f iled between 1985 and 1987 against a large metropolitan medical center . Information extracted from each deposition included the alleged inju ry; the presence of the question, ''Why are you suing?'' and, if prese nt, the answer; the presence of problematic relationship issues betwee n providers and patients and/or families and, if present, the discours e supporting it; the presence of the question, ''Did a health professi onal suggest maloccurrence?'' and, if yes, who. Using a process of con sensual validation, relationship issues were organized into groups of more generalized categories suggested by the data. Answers to the ques tions, ''Why are you suing?'' and ''Who suggested maloccurrence?'' are described. Results: Problematic relationship issues were identified i n 71% of the depositions with an interrater reliability of 93.3%. Four themes emerged from the descriptive review of the 3787 pages of trans cript: deserting the patient (32%), devaluing patient and/or family vi ews (29%), delivering information poorly (26%), and failing to underst and the patient and/or family perspective (13%). Thirty-one plaintiffs were asked if health professionals suggested maloccurrence. Fifty-fou r percent (n=17) responded affirmatively. The postoutcome-consulting s pecialist was named in 71% (n=12) of the depositions in which maloccur rence was allegedly suggested. Conclusions: In our sample, the decisio n to litigate was often associated with a perceived lack of caring and /or collaboration in the delivery of health care. The issues identifie d included perceived unavailability, disdounting patient and/or family concerns, poor delivery of information, and lack of understanding the patient and/or family perspective. Particular attention should be pai d to the postadverse-event consultant-patient interaction.