Medicolegal pressures improve communications with patients
20th March 2011
Doctors’ communications with patients have improved due to concerns about the medicolegal consequences of poor communication, Dr Louise Nash and her colleagues have reported in the Medical Journal of Australia.
Doctors communications with patients have improved due to concerns about the medicolegal consequences of poor communication, Dr Louise Nash and her colleagues have reported in the Medical Journal of Australia.1
In the largest study of its kind in Australia, of 3,000 respondents (GPs, surgeons, O&Gs, anaesthetists and other specialists), Dr Nash found that:
- Eight out of 10 doctors provided more treatment information to patients due to medicolegal concerns
- Two out of three doctors reported improved communications of risk
- About half were more attentive to patients
- About half reported increased disclosure of uncertainty
- Half developed better systems for tracking results, and
- About four out of ten doctors developed better methods for identifying non-attenders and for auditing clinical practice.
While medicolegal pressures appeared to improve processes of communication with patients, some doctors were also adversely affected by medicolegal pressures.
For example, Dr Nash reported that doctors’ worries about medicolegal issues led 33% of them to consider giving up medicine, 32% considered reducing their working hours, and 40% considered early retirement.
Dr Nash said the team’s conclusions were similar to international studies and confirmed that Australian doctors’ experience with medicolegal issues affected and impacted on their practice.
The impact of previous medicolegal complaints significantly increased the practice of defensive medicine.
International studies have reported that medicolegal pressures cause both negative and positive outcomes, including:
- Excessive referrals
- Excessive ordering of tests and diagnostic imaging
- Excessive prescribing of medication
- Avoidance of certain patients or procedures
- More information being given to patients
- More reflective practice
- Greater sensitivity to societal and professional expectations
- Willingness to make system improvements, such as better audit procedures and record keeping.
While about half of the doctors believed that they had to make perfect decisions under the law, Dr Nash said the law does not demand perfection.
“The High Court of Australia in Rogers v Whitaker established that the law imposes on a medical practitioner a duty to exercise reasonable care and skill in the provision of professional advice and treatment” she said.
“Training in patient safety and medicolegal aspects of medical practice will help doctors to be better informed and to better understand how such issues influence their judgment and decision making.”
The authors concluded that doctors need education about the medicolegal environment and an understanding how medicolegal matters can affect their practice of medicine.
Reference
1. Louise M. Nash, Merrilyn M. Walton, Michele G. Daly et al. Perceived practice change in Australian doctors as a result of medicolegal concerns. Medical Journal of Australia 2010;193(10):579-583.
(Dr Louise M. Nash, FRANZCP, Coordinator, Postgraduate Course in Psychiatry, NSW Institute of Psychiatry, Sydney, NSW)