Empathy in medicine: Insight from malpractice cases rejected by attorneys

No physician wants to think about the prospect of being sued, but litigation can be a stressful process for both doctors and patients. Athough many medical malpractice cases never go to trial, even the cases that are dismissed or finalized through out-of-court settlements can teach physicians important lessons about improving patient care and safety, the doctor-patient relationship, and staying on top of documentation.^[]

The significant patient impact

Jeanine Thomas of Hinsdale, IL, never imagined that routine ankle surgery would lead to a cascade of health problems. 

In November 2000, after slipping on ice and breaking her ankle, Thomas tells MDLinx she underwent surgery to have orthopedic hardware implanted. While the operation was successful, Thomas soon became critically ill with antibiotic-resistant, Methicillin-resistant Staphylococcus aureus (MRSA) that led to a life-threatening case of septic shock and organ failure.

Patients like Thomas typically file medical malpractice claims because of errors relating to diagnosis, prescriptions, surgery, childbirth, and anesthesia. However, as she learned, many malpractice cases never see the light of day because patients are unable to find attorneys willing to take their case. 

“I had two doctors who aren’t affiliated with the hospital tell me that since the infection went into my bone marrow, it was most likely caused by contaminated surgical instruments,” Thomas says.

It’s not uncommon for attorneys to decline malpractice cases when costs exceed the damages, or if proving liability is difficult.^[]

Why patients file malpractice lawsuits

For most patients who attempt to sue for malpractice, litigation goes far beyond receiving compensation. It also means holding medical professionals accountable and ensuring new procedures are implemented to keep patients safe.

Such was the case with Thomas, who launched The MRSA Survivors Network in 2003. Her nonprofit advocates for an aggressive and comprehensive approach to eradicating MRSA that includes screening all high-risk patients, isolation, strict hand hygiene, use of gloves and gowns, and decontaminating the environment. Thomas also recommends patients get screened for MRSA prior to surgery and wash themselves with chlorhexidine at home before entering the hospital.

Kimberly Turbin of Reseda, CA, also attempted to pursue litigation after a traumatic birthing experience, which she shared with the nonprofit, Patients for Fairness.^[] Her case was turned down by 80 attorneys. A rape survivor, Turbin carefully explained the trauma she had experienced from being sexually assaulted and asked the medical staff if they could provide safety and transparency during her birthing process.

However, two pushes into delivering her son, Turbin’s doctor told her he wanted to do an episiotomy. When Turbin calmly declined, noting that her delivery was progressing normally, her doctor became hostile and defensive. Although Turbin wanted to give birth naturally, her doctor proceeded to make 12 incisions, leaving her emotionally and physically traumatized. 

 Patients are seeking accountability and answers

When a patient files a malpractice suit, their motives typically extend far beyond receiving a financial settlement. One study identified four predominant reasons that prompt patients to file a malpractice suit.^[] They are as follows:

1. The desire to prevent a similar bad incident from happening again

2. A need for an explanation as to why the incident happened

3. A desire for financial compensation to make up for actual losses, for pain or suffering, or for the cost of providing future care for the injured patient

4. A desire to hold doctors accountable for their actions

Carla Keirns, MD, PhD, MSc, FACP, an associate professor of palliative medicine at the University of Kansas Medical Center, tells MDLinx that when an adverse medical event occurs, it's important for patients to feel as though they’re being heard and understood. 

“Patients want to know what caused their adverse event and to receive reassurance it won’t happen again to other patients,” Dr. Keirns tells MDLinx. “Their decision to take legal action is often driven by how they were treated by physicians and hospital staff."

Studies reinforce the importance of empathy, showing that doctors who demonstrate empathy have lower malpractice rates and better patient satisfaction and compliance.^[]

Many experts recommend a four-step approach to self-forgiveness that involves responsibility, remorse, restoration, and renewal.^[]

In recent years, many hospitals have adopted a proactive and transparent approach to addressing medical errors and other adverse events. The Agency for Healthcare Research and Quality developed a free online Communication and Optimal Resolution (CANDOR) toolkit in 2016, which illustrates how to engage patients and families in disclosure communication following adverse events, while also supporting and caring for doctors and other staff involved.^[]

There’s evidence these communication and resolution programs work. One study looked at a CARe (Communication, Apology, and Resolution) initiative introduced in six Massachusetts hospitals.^[] The study found the CARe program was successful and didn’t bring forth a barrage of new lawsuits. CARe also provided “care for the caregivers” after adverse events—signaling that the hospital’s caring relationship with the patient continues after an injury occurs, while reassuring clinicians that unfair blame is not being placed.