Conversations with Patients: A note to my physician friends

We all hear a lot about the effect of how physicians speak to patients affects patient satisfaction. Things you’ve heard from many others – sit down when you talk to them, introduce yourself to patient and family in room, listen actively.

Doctor and Patient
The doctor/patient interaction we all dream of

Yada, yada, yada. Right? More corporate BS from someone who doesn’t have anything better to do. After all, doctors know how to talk to patients. What words to use. How to get our point across.

But let’s make it a bit more personal – how do our conversations with patients affect our malpractice risk?


I came across this when reading “Blink” by Malcolm Gladwell. For those of you who haven’t read it, Gladwell is trying to show how we can “thin-slice” decisions fairly accurately with very little information, and without conscious thought. One example he gives is of a veteran Lieutenant in a fire department who brought his men in to fight a kitchen fire. As they began to work, something felt strange to him. The fire didn’t go out with water, which kitchen fires do. It wasn’t as noisy as it should have been. And when they retreated to the living room, it was much hotter than it should have been. Now, the Lt. didn’t consciously think any of these things at that point – Gladwell reconstructed it with him later. He just knew something wasn’t right, and he yelled to get his men out of the living room. And the floor then collapsed because the fire was actually in the basement.

The thing that struck me in regards to us was a study Gladwell quotes on patients’ perceptions of doctors (reference below). The authors tape recorded 125 conversations between doctors (divided equally between surgeons and primary care) and 10 consecutive patients per doctor. ½ of the docs had been sued at least twice, the rest had never been sued. The docs who had never been sued spent more than 3 minutes longer with each patient and were more likely to make “orienting” comments, like “First I’ll examine you, and then we’ll talk the problem over” or “I will leave time for your questions”. These statements give a sense of what the visit is to accomplish and that the patients are expected to participate. The non-sued docs were also more likely to laugh and be funny. There was no difference in the amount or quality of information they gave the patients, though.

This is somewhat interesting, but the next phase is really valuable. Another psychologist listened to the same tapes just for surgeons and their patients. She took only 2 of the patient conversations for each surgeon, then selected two 10 second clips of each doctor talking, giving her 40 seconds of each surgeon speaking. She then removed the high-frequency sounds from speech so individual words could not be recognized, just tone, pitch, and rhythm with no content. Judges rated these slices of garble, looking for qualities of warmth, hostility, dominance, and anxiousness. By using these, she could identify which surgeons got sued and which ones didn’t.

Let me emphasize that – they could predict who had been sued ONLY BY ANALYZING UNINTELLIGABLE TONE OF VOICE!

That is astounding to me. But picture this – if you were felt to be “dominant”, you were in the sued group. Doesn’t that make sense intuitively to you? By being dominant, you convey a lack of respect for the patient, which they certainly perceive quickly – I know I can.

Try this – have someone listen to your tone from outside an exam room and have them tell you what emotion you projected. Warmth? Or Dominance?


Do you ever feel doctors are like this with you?



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