DOCTOR PATIENT COMMUNICATIONS AND MEDICAL MALPRACTICE

目的：医疗事故处理改革是国家的重中之重。 AHCPR关于医疗责任的会议推荐“高风险”行为 将医生交流作为一个研究领域。这项建议 具体解决了这一确定的需求。我们建议探索 与医生沟通模式和医疗事故风险相关的问题 在两个层面上。首先，我们将检查医生的常规方面 加强或削弱医患之间的沟通方式 关系和影响医生提出医疗事故索赔的风险。 第二，我们将调查医生和医生之间的关系 察觉到潜在不当行为的威胁，报告的做法 “防御性医学”和他们的交流模式。 参与者：100名初级保健和外科医生 在俄勒冈州和科罗拉多州实践的专业，将参加 学习。医生咨询委员会将招聘医生 参与者将根据既往医疗事故选择医生 索赔历史，50个没有索赔，50个有两个或更多索赔， 在实践和专业上按时间长短分层。 方法：研究将采用定量和定性相结合的方法。 方法：研究方法。每名医生将录制10盘录音带 例行的办公室访问，这些录音带将形成数据库 分析。此外，信息将直接从以下地点收集 医生反映医生对医疗事故的恐惧，报告 “防御性医学”的实践，对心理社会的态度 病人护理和工作满意度的各个方面。每名患者10名 医生将填写离职问卷，医生也将于 就诊的各个方面，如就诊原因、患者的身体状况、 情感和功能状态；以及对相遇的满意度。 定量分析将基于Roter相互作用的使用 黛布拉·罗特博士监督下的分析系统。定性的 分析将利用微观互动的框架和方法 在理查德·弗兰克尔博士的指导下进行分析。评选结果 定量和定性分析将通过一系列的分析进行比较 调查人员之间的讨论。统计方法将 包括使用嵌套Manova、嵌套ANOVA和判别分析 来检验研究假设。 未来研究：本研究的长期目标是应用分析 制定持续医学教育(CME)课程的结果 专门针对发现的“高风险”沟通行为 与更高的医疗事故风险密切相关。未来 研究将严格测试这些持续的继续医学教育的效果。 改变医生交流行为的计划，这反过来， 将提高护理质量，降低医疗事故风险。

OBJECTIVE: Medical malpractice reform is a high national priority. AHCPR's Conference on Medical Liability recommended "high-risk" behaviors in physician communication as an area for research. This proposal specifically addresses this identified need. We propose to explore issues related to physicians' communication patterns and malpractice risk on two levels. First, we will examine routine aspects of physicians' communication styles that either enhance or undermine the doctor-patient relationship and influence physicians' risk for malpractice claims. Second, we will investigate the relationship between physicians' perceived threat of potential malpractice, reported practice of "defensive-medicine," and their communication patterns. PARTICIPANTS: One-hundred physicians in primary care and surgical specialties in practice in Oregon and Colorado, will participate in the study. An Advisory Board of physicians will recruit physician participants Physicians will be selected based on prior malpractice claims history, 50 with no claims and 50 with two or more claims, stratified for length of time in practice and specialty. METHODS: The study will utilize both quantitative and qualitative methods. For each physician, 10 audiotapes will be recorded during routine office visits, and these audiotapes will form the database for analysis. In addition, information will be gathered directly from physicians to reflect physicians' perceived fear of malpractice, report of "defensive-medicine" practice, attitudes regarding psychosocial aspects of patient care, and job satisfaction. Ten patients per physician will complete exit questionnaires, as will the physicians, on aspects of the visit, such as reason for visit; patient's physical, emotional, and functional status; and satisfaction with the encounter. Quantitative analysis will be based on use of the Roter interactional Analysis System under the supervision of Dr. Debra Roter. Qualitative analysis will utilize the framework and methods of microinteractional analysis under the direction of Dr. Richard Frankel. Results of the quantitative and qualitative analysis will be compared through a series of discussions between the investigators. Statistical methods will include the use of nested MANOVA, nested ANOVA, and discriminant analysis to test the study hypotheses. FUTURE STUDIES: The long-term goal of this study is to apply the analytic results in formulating a continuing medical education (CME) curriculum that specifically targets the "high-risk" communication behaviors found to be most closely associated with increased malpractice risk. Future studies will rigorously test the efficacy of these continuing CME programs in changing physician communication behaviors which, in turn, will improve quality of care and reduce malpractice risk.