Abstract
Purpose
A small number of physicians generate a disproportionate share of complaints from
patients and of malpractice lawsuits. If these grievances relate to patients’ dissatisfaction
with care, it might be possible to use commonly distributed patient satisfaction surveys
to identify physicians at high risk of complaints from patients and of malpractice
lawsuits. We sought to examine associations among patients’ satisfaction survey ratings
of physicians’ performance and complaints from patients, risk management episodes,
and rates of malpractice lawsuits.
Subjects and methods
We examined 353 physicians at a large US teaching hospital whose inpatient performance
was rated by 10 or more patients between January 1, 2001, and March 31, 2003. Physicians
were divided into 3 tertiles according to satisfaction on a commercial survey instrument
administered to recently discharged patients. Records of unsolicited complaints from
patients (January 1, 2000, to March 31, 2003) and risk management episodes (January
1, 1983, to March 31, 2003) were analyzed after adjusting for the physician’s specialty
and panel characteristics of the physician’s patients.
Results
Decreases in physicians’ patient satisfaction survey scores from the highest to the
lowest tertile were associated with increased rates of unsolicited complaints from
patients (200 vs 243 vs 492 complaints per 100 000 patient discharges; P <0.0001) and risk management episodes (29 vs 43 vs 56 risk management episodes per
100 000 patient discharges; P = 0.007). Compared with physicians with the top satisfaction survey ratings, physicians
in the middle tertile had malpractice lawsuit rates that were 26% higher (rate ratio
[RR] = 1.26; 95% confidence interval [CI]: 0.72 to 2.18; P = 0.41), and physicians in the bottom tertile had malpractice lawsuit rates that
were 110% higher (RR = 2.10; 95% CI: 1.13 to 3.90; P = 0.019).
Conclusion
Patient satisfaction survey ratings of inpatient physicians’ performance are associated
with complaints from patients and with risk management episodes. Commonly distributed
patient satisfaction surveys may be useful quality improvement tools, but identifying
physicians at high risk of complaints from patients and of malpractice lawsuits remains
challenging.
Keywords
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Article info
Footnotes
This project was supported by a research grant from the Harvard Risk Management Foundation. Dr. Stelfox was supported by a Postdoctoral Fellowship award from the Canadian Institutes of Health Research, a Walker Fellowship from Harvard Medical School, and the Clinician-Scientist Program of the Department of Medicine at the University of Toronto. Funding sources had no role in the design, conduct, or reporting of this study.
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Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
