Medicolegal pressures improve communications with patients

By John Connole
Sunday, 16 September, 2012

Doctors' communications with patients have improved due to concerns about the medicolegal consequences of poor communication, Dr Louise Nash and her colleagues report.

In the largest study of its kind in Australia, of 3,000 respondents (GPs, surgeons, O&Gs, anaesthetists and other specialists), the researchers found that:

  • eight out of 10 doctors provided more information to patients due to medicolegal concerns

  • two out of three doctors reported improved communications of risk

  • about half are more attentive to patients

  • about half reported increased disclosure of uncertainty

  • half developed better systems for tracking results, and

  • about four of ten doctors developed better methods for identifying nonattenders and for auditing clinical practice.

While medicolegal pressures appeared to improve processes of communication with patients, some doctors were also adversely affected by these pressures.

For example, Dr Nash reported that doctors’ worries about medicolegal issues led 33 per cent of them to consider giving up medicine, 32 per cent considered reducing their working hours, and 40 per cent considered early retirement.

Dr Nash said the team’s conclusions were similar to international studies and confirmed that doctors’ experience with medicolegal issues affected their practice.

The impact of previous medicolegal complaints significantly increased the practice of defensive medicine. International studies have reported that medicolegal pressures result in:

  • 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.

She said, “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.”

The authors concluded that doctors need education about the medicolegal environment and an understanding how medicolegal matters can affect their practice of medicine.

“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,” they said.

Another aspect of their study addressed factors associated with psychiatric morbidity in doctors. Three work-related factors were significantly associated with psychiatric morbidity:

  • having a current medicolegal matter

  • not having a holiday in the previous 12 months

  • working long hours.

Nash and colleagues believe that the mental health of medical practitioners is crucial to the quality of care their patients receive. Doctors should reflect on their hours of work and need for holidays. Involvement with medicolegal processes, such as lawsuits, complaints and inquiries, is a stressful part of medical practice today. Doctors need to be educated about these processes and understand how the experience may affect their health, work and loved ones.2

Help with informed consent
An easy and inexpensive means of assisting the informed-consent process is to provide your patients with a patient education pamphlet that details their impending surgical or diagnostic procedure. On behalf of 25 medical and dental colleges, societies and associations in Australia and New Zealand, Mitec Medical Publishing publishes more than 200 patient education pamphlets on the most common procedures.

The text and medical illustrations in each full-colour pamphlet have been extensively peer reviewed by specialists, with the crest or logo of the organisation on the front page. A helpful device is the lift-off sticker on the pamphlets, which provides confirmation that you have provided the pamphlet to your patient.

Treatment topics include general surgery, colorectal, otolaryngology, head and neck, cardiothoracic, neurosurgery, urology, ophthalmology, orthopaedics, obstetrics and gynaecology, plastic and reconstructive, vascular, bariatric, oral and maxillofacial, dental, and anaesthesia, among others.

For a complete list of pamphlets, visit or call Mi-tec on 03 9888 6262 to receive samples of patient pamphlets in your specialty. If you would like us to develop a patient education pamphlet in your specialty, ask for Dr Calvin Miller.

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