Small Dose Of Patience Can Deter Lawsuits

“Patients don’t file lawsuits because they’ve been harmed by shoddy medical care. Patients file lawsuits because they’ve been harmed by shoddy medical care and something else happens to them.”

What that “something else” is, yours truly discovered in “Blink,” a fascinating book and best-seller written by Malcolm Gladwell.1

The author was writing about physicians and human surgeons, but his analysis certainly pertains to veterinarians in general and veterinary surgeons in particular. A malpractice insurance company was trying to predict which surgeon would be most likely to be sued. The researchers listened to very short excerpts of recorded conversations between surgeons and patients. The study revealed the “something else.”

“It’s how they were treated, on a personal level, by their doctor,” Gladwell explains. “What comes up again and again in malpractice cases is that patients say they were rushed or ignored or treated poorly.”

Gladwell quotes a malpractice lawyer: “People just don’t sue doctors they like.”

Gladwell also refers to a 1997 article by Wendy Levinson, et al.2 The results are astonishing. What is the difference between patients who felt rushed and the happy others? Malpractice-accused surgeons spent an average of 15 minutes with their patients.

Never-sued surgeons spent an average of 18 minutes with theirs. So the difference is a paltry three minutes!

“Good” surgeons were more likely to make “orienting” comments such as “First I’ll examine you and then we will talk the problem over” or “I will leave time for your questions.” These approaches help patients get a sense of what the visit is supposed to accomplish and when they ought to ask questions, Gladwell writes.

Gladwell explains that “good” surgeons “were more likely to engage in active listening, saying such things as ‘Go on, tell me more about that,’ and they were far more likely to laugh and be funny during the visit. Interestingly, there was no difference in the amount or quality of information they gave their patients; they didn’t provide more details about medications or the patient’s condition. The difference was entirely in how they talked to their patients.”

In other words, as the saying goes, “It’s not what you say, it’s how you say it.”

A psychologist, Nalini Ambady, listened to Levinson’s tapes. She asked people to rate snippets of conversation on criteria such as warmth, hostility, dominance and anxiousness. Based on that information alone (i.e. nobody knew about the surgeon’s skill and experience level), her study predicted  which surgeons got sued and which ones didn’t.3

Gladwell summarizes: “If the surgeon’s voice was dominant, the surgeon tended to be in the sued group. If the voice sounded less dominant and more concerned, the surgeon tended to be in the non-sued group.”

It may be wise to avoid medical jargon. We all know it, but do we really do it? There are two consequences of using fancy words: Clients may not understand what you are talking about, or they may think you are hiding your uncertainty about their pet’s condition behind technical words.

For example, is it really that important to talk about the CCL (cranial cruciate ligament) when most clients have heard about the ACL (anterior cruciate ligament)? Must we keep talking about the thorax and the abdomen when “chest” and “belly” will do? Instead of hyperthyroidism or hypothyroidism, could be perhaps talk about a hyperactive thyroid or a lazy thyroid?

The point is certainly not to take clients for idiots, but to make sure they truly understand our message.

If clients really retain 20 percent of what we say, let’s at least try to simplify things! Or at the very least, we could adjust to the client we’re facing. It is certainly acceptable to mention a “thoracic” mass to a registered nurse or to discuss hyperadrenocorticism with an anatomy professor!

Next time you walk into an exam room, you might want to say, “Let’s look at Fluffy’s sore leg, then we’ll talk, and then we can answer any question you have.” See how your client likes it.

And then, spend an extra three minutes with that client. <HOME>

Dr. Phil Zeltzman is a small animal board-certified surgeon at Valley Central Veterinary Referral Center in Whitehall, Pa. His website is


1. Malcolm Gladwell. “BLINK: The Power of Thinking Without Thinking.” Back Bay Books, 2005.

2. W. Levinson, et al.“Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.” JAMA, 1997, Vol. 277, pgs. 553-559.

3. N. Ambady, et al. “Surgeons’ tone of voice: A clue to malpractice history.” Surgery, 2002, Vol. 132, pgs. 5-9.


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